One patient in the MD group received 36 mg as the inpatient team ordered an additional buprenorphine 20 hours into the admission while the patient boarded in the ED. The Spearman correlation of dose administered by time was 0.23 ( P < .001) overall, 0.19 ( P = .005) for MDs, and 0.22 ( P < .001) for APPs. B, Total buprenorphine dose administered per encounter by calendar time (in quarter years) of encounter. MDs provided high-dose buprenorphine in 71 of 220 patient encounters (32%), and APPs provided high-dose buprenorphine in 181 of 359 encounters (50%). Kruskal-Wallis test compares distributions of respiratory rate and oxygen saturation across buprenorphine dose categories.
Boxes correspond to 25th and 75th percentiles, with lines in boxes denoting medians. Each dot represents a unique patient encounter. High doses may produce sedation, respiratory depression, nausea, and headache the duration and magnitude of withdrawal suppression is greater.Ī, Total doses are shown. A starting dose of 8 mg sublingual should be considered in moderate-to-severe withdrawal.ĬBuprenorphine, sublingual monoproduct was used.ĭStandard dose induction (8-12 mg) is associated with a lower risk of sedation, respiratory depression, and adverse effects, such as nausea and headache, particularly in patients with complicating factors the duration and magnitude of withdrawal suppression is less. AComplicating factors include age 65 years or older altered mental status viable pregnancy methadone use intoxication with alcohol, benzodiazepines, or other sedatives postoverdose reversal with naloxone anticipated surgery long-term opioid therapy for pain or any serious acute medical illness, such as heart failure, liver failure, kidney failure, or respiratory distress.īWithdrawal is a clinical determination based on the Clinical Opiate Withdrawal Scale (COWS): mild, 5-12 moderate, 13-24 severe, greater than 25.
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