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Ann Intern Med. 2018 Nov 6;169(9):628-635. doi: 10.7326/M18-1652. Epub 2018 Oct 23.

The Next Stage of Buprenorphine Care for Opioid Use Disorder.

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University of Massachusetts Medical School and Barre Family Health Center, Barre, and CleanSlate Research and Education Foundation, Florence, Massachusetts (S.A.M.).
University of Massachusetts Amherst College of Nursing, Amherst, and CleanSlate Research and Education Foundation, Florence, Massachusetts (L.M.C., J.D.B.).
CleanSlate Research and Education Foundation, Florence, Massachusetts (A.W.).


Buprenorphine has been used internationally for the treatment of opioid use disorder (OUD) since the 1990s and has been available in the United States for more than a decade. Initial practice recommendations were intentionally conservative, were based on expert opinion, and were influenced by methadone regulations. Since 2003, the American crisis of OUD has dramatically worsened, and much related empirical research has been undertaken. The findings in several important areas conflict with initial clinical practice that is still prevalent. This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment. For each area, evidence for needed updates and modifications in practice is provided. These modifications will facilitate more successful, evidence-based treatment and care for patients with OUD.


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