Magazine article Addiction Professional

Patient Assessment and Selection for Buprenorphine Treatment

Magazine article Addiction Professional

Patient Assessment and Selection for Buprenorphine Treatment

Article excerpt

Laura F. McNicholas, M.D., Ph.D., says buprenorphine is not a difficult medication to manage in patients, and she should know.

McNicholas is a clinical associate professor in psychiatry at the University of Pennsylvania and director of the Center of Excellence for Substance Abuse Treatment and Education at the Veterans Affairs Medical Center in Philadelphia. She also served on the faculty for "Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence," a daylong training session for physicians at the American Academy of Addiction Psychiatry's (AAAP's) annual meeting last December.

"After the first couple of patients, most people get very comfortable in assessing patients and getting patients started and managed," she says. "The first couple are nerve-wracking."

First, a candidate for buprenorphine treatment must have an objectively ascertained diagnosis of opioid dependence as defined in the latest edition of the DSM-IV-TR, 2000. Once that is established, McNicholas begins with taking the candidate's complete physical history, including a thorough drug history.

While gathering information at the first meeting, she says, she is taking a reading of how she and the candidate are interacting. The practitioner needs to be respectful, non-judgmental and open to the candidate's concerns; in return he/she needs to feel some confidence in the candidate's feedback.

"And then you check," says McNicholas. "You do your physical exam and your laboratory workup and a urine toxicology for everything you can think of and see whether the candidate is being upfront with you."

McNicholas does not start treatment on the candidate's first visit. Rather, she has the evaluation visit and makes an appointment for the induction visit. In between, she gets her lab results back, so she can make her decision taking those results into account.

Match setting to patient needs

Whether it's office- or clinic-based, figuring out what a practice can handle really defines what factors you need to look for in a candidate, says McNicholas.

The law presently says that an individual or group practice cannot treat more than 30 buprenorphine patients at any given time, with one caveat: If you are in an opiate treatment program you may take as many patients as you want. …

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