Buprenorphine/Naloxone, Oral, Greater Than 10 mg Buprenorphine (J0575)

Name of the Procedure:

• Common Name: Buprenorphine/Naloxone therapy
• Technical Term: Buprenorphine/Naloxone oral administration, ≥ 10 mg Buprenorphine

Summary

Buprenorphine/naloxone, commonly administered in an oral form, is a medication used to treat opioid dependence. This specific dosage involves a buprenorphine component greater than 10 mg, combined with naloxone to prevent misuse.

Purpose

Buprenorphine/naloxone is used to help individuals overcome opioid addiction. It reduces withdrawal symptoms and cravings, helping patients transition away from opioid use and towards recovery. The goal is to stabilize the patient and facilitate recovery from opioid dependence.

Indications

• Patients diagnosed with opioid use disorder
• Individuals experiencing moderate to severe opioid withdrawal symptoms
• Those who have undergone initial detoxification and require maintenance therapy

Preparation

• Pre-Procedure Instructions: Patients should avoid consuming any opioids at least 12-24 hours before initiating buprenorphine/naloxone therapy to reduce the risk of precipitated withdrawal.
• Diagnostic Tests: A thorough medical evaluation, including a history of substance use and physical examination, may be required. Urine or blood tests might be conducted to rule out other drugs.

Procedure Description

1. Initial Assessment: A healthcare provider evaluates the patient's condition and appropriateness for buprenorphine/naloxone therapy.
2. Induction Phase: Starting with a lower dose, the patient is carefully monitored as the dosage is gradually increased to greater than 10 mg of buprenorphine.
3. Maintenance Phase: Once the optimal dose is reached, the patient continues the medication daily to manage opioid dependence.

4. Medication Form: The medication is typically provided as a sublingual tablet or film.

   Tools: Sublingual tablets/films, prescribing information. Anesthesia or sedation is not required.

Duration

The induction phase may take 1-3 days, while the maintenance phase can last months or even years, depending on the patient's progress.

Setting

• The procedure is usually carried out in an outpatient clinic or a healthcare provider's office.

Personnel

• Primary Care Physician
• Addiction Specialist
• Nurse Practitioner
• Pharmacist

Risks and Complications

• Common Risks: Headache, nausea, constipation, insomnia, sweating
• Rare Risks: Allergic reactions, respiratory depression, liver damage
• Management: Close monitoring and dose adjustments, supportive care for side effects

Benefits

• Reduces opioid cravings and withdrawal symptoms
• Improves patient stability and overall functionality
• Facilitates long-term recovery and reduces the risk of opioid overdose
• Benefits usually become evident within days to weeks of starting therapy.

Recovery

• Post-Procedure Care: Regular follow-up appointments to monitor progress and adjust dosage
• Expected Recovery Time: Ongoing, as long-term treatment is often necessary
• Restrictions and Follow-Up: Patients should avoid opioids and other substances; frequent visits with healthcare providers for monitoring.

Alternatives

• Methadone: An alternative opioid agonist treatment, but with stricter regulation and higher risk of dependency.
• Naltrexone: A non-opioid medication that blocks opioid receptors, requiring complete detoxification before use.
• Pros and Cons: Methadone is highly regulated and has abuse potential. Naltrexone requires full detox and may not manage withdrawal symptoms as effectively.

Patient Experience

Patients may experience mild discomfort from withdrawal symptoms initially but typically feel significant relief from opioid cravings and withdrawal within a few days of starting buprenorphine/naloxone therapy. Pain management is generally not required, but close monitoring helps ensure the patient's comfort and safety.

This structured layout offers a comprehensive view of the buprenorphine/naloxone procedure, outlining essential details for patients and healthcare providers.