Skip to main content
Top of the Page
MOUD Treatment and Buprenorphine Prescribing: Safe Practices

MOUD Treatment and Buprenorphine Prescribing: Safe Practices

With the explosion of fentanyl- and opioid-related deaths, the need for treatment of opioid use disorder has never been greater. The removal of the X-waiver for buprenorphine prescribing has resulted in increased opportunity to treat OUD in a variety of clinical settings. Click here for more on the history of the X-wavier and the Mainstreaming Addiction Treatment Act. An excellent opinion piece by Lucinda Grande, MD, is available here.

Guideline

Patients suffering from OUD should be considered for in-clinic or home initiation of buprenorphine in the right clinical setting.

BPBT Acute Buprenorphine Prescribing Reports

  • Launched in 2024, the BPBT Acute Buprenorphine Prescribing Reports provide feedback on the number of prescriptions written by prescribers for patients with OUD that have not received buprenorphine in the prior 105 days.
  • Each quarter, the WSMA distributes individual prescriber reports by email for free. Prescribers may monitor their prescribing over time and, if appropriate, make changes.
  • Data definitions and metric specifications are available.

Quick Facts

  • With the removal of the X-waiver, any licensed prescriber with a DEA number practicing within their scope of practice can legally prescribe buprenorphine.
  • Buprenorphine is extremely difficult to overdose on when used properly and without other sedative medications.
  • The risk of precipitated withdrawal increases closer to recent fentanyl use. The risk is highest (OR 5.2) with use in the prior 24 hours.i
  • Initiating treatment when a patient presents for help is twice as effective at maintaining engagement at one month (78% versus 37%) and reduced illicit opioid use five-fold over outpatient referral for treatment.ii
Download Safe Practices One-Pager

Resources and References

Resources

The following are examples of buprenorphine protocols and resources. If you are interested in starting buprenorphine treatment in the clinic or outpatient setting, these protocols could be a starting point for considerations.

WSMA Addiction Medicine Training. Comprehensive training to meet the new eight-hour requirement for DEA renewal.

SAMHSA. Buprenorphine Quick Start Guide. Condensed overview of buprenorphine, side effects, efficacy, and an induction schedule with relevant testing for risk assessment.

California Bridge Program. Extensive program with relevant patient and prescriber materials on how to do buprenorphine initiation including:

High Dose Buprenorphine Initiation in the Emergency Department Among Patients Using Fentanyl and Other Opioids. v Article discussing the efficacy and safety of high-dose buprenorphine in the early stages of the fentanyl portion of the epidemic using the California Bridge Program. Data demonstrates limited precipitated withdrawal in the fentanyl population.

UW Psychiatry Consultation Line provides clinical advice regarding adult patients with mental health or substance use disorders. Contact them at 877.WA.PSYCH (877.927.7924) or pclwa@uw.edu.

ACEP Webinar on ED initiation of Buprenorphine. Thorough introduction to initiation protocols.

References

i. Varshneya NB, Thakrar AP, Hobelmann JG, Dunn KE, Huhn AS. Evidence of Buprenorphine-precipitated withdrawal in persons who use fentanyl. J Addict Med. 2022 Jul-Aug; 16(4): e265–e268.

ii. D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency department-initiated buprenorphine / naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015 Apr 28;313(16):1636-44.

iii. SAMHSA. Buprenorphine Quick Start Guide.

iv. California Bridge Program. Buprenorphine Guide, EQ Quick Start, and Home Quick Start Guide.

v. Snyder H, Chau B, Kalmin MM, Speener M, Campbell A, Moulin A, Herring AA. High Dose Buprenorphine Initiation in the Emergency Department Among Patients Using Fentanyl and Other Opioids. JAMA Network Open. 2023;6(3):e231572. doi:10.1001/jamanetworkopen.2023.1572.

Join or renew your membership today!
Join/Renew