#187

Описание: How to initiate buprenorphine like a pro. Treating people with Opioid Use Disorder can be the most rewarding part of your practice! Get comfortable with counseling and pharmacotherapy for OUD with tips from Dr. Michael Fingerhood, Associate Professor of Medicine at Public Health at Johns Hopkins. We review building a therapeutic relationship with people with substance use disorders, the differences between the three FDA-approved medications for opioid use disorder (buprenorphine, methadone and extended-release naltrexone), and the nitty-gritty of prescribing buprenorphine.

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Credits Written and Produced by: Justin Berk, MD MPH MBA, Joseph “Seffy” Muller MD Infographic: Hannah R Abrams and Justin Berk MD, MPH, MBA Cover Art: Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Justin Berk, MD MPH MBA Editor: Matt Watto MD, FACP (written materials), Clair Morgan at Nodderly.com (audio) Guest: Michael Fingerhood MD Time Stamps 00:00: Introduction 04:40: Guest introduction & questions (great stories about addiction) Picks of the Week*: Papillon (film) and Papillon (book) per Dr. Fingerhood; Miami Connection (film) per Stuart, Watto and Paul; Use GREPMED as “the Pinterest of medical education”, per Dr. Justin Berk; ASAM Handbook of Addiction Medicine by Dr. Fingerhood and Dr. Darius Rastegar; Bup App (from Yale School of Medicine) 16:45: How to approach someone with addiction looking for help 20:00: Choosing between methadone and buprenorphine 24:15: Different formulations of buprenorphine 26:45: Coverage and costs of buprenorphine 28:20: Safety considerations of buprenorphine 33:40: How to divide buprenorphine films for specific dosing 35:00: Discussion of buprenorphine diversion 36:20: Home initiation of buprenorphine 40:00: Use of urine toxicology screens and addressing concurrent use 41:00: Initiation of buprenorphine in patients actively using 42:30: How to address precipitated withdrawal 45:00: Treating chronic pain and transitioning to buprenorphine 47:00: Treating acute pain for patients on buprenorphine 51:00: Dosing of buprenorphine 52:15: Perceived barriers to buprenorphine (e.g. counseling resources, “trading addiction”) 57:10: Historical context of opioid use disorder 60:00: Take home points 62:40: Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures Dr. Fingerhood reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation Fingerhood M, Berk JL, Muller J, Williams PN, Brigham SK, Watto MF. “#187 Buprenorphine 2.0: Managing Opioid Use Disorder for the Generalist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 9, 2019.