J Dual Diagn ; 16 — Subst Abuse Treat Prev Policy ; 15 Rapid evidence review of harm reduction interventions and messaging for people who inject drugs during pandemic events: implications for the ongoing COVID response. A person-centered approach to harm reduction is highlighted. Calls for access to safe injecting supplies as a critical public health measure during the COVID pandemic.
COVID and overdose prevention: challenges and opportunities for clinical practice in housing settings. Driving access to care: use of mobile units for urine specimen collection during the coronavirus disease COVID pandemic. Acad Pathol ; 7 Wenzel K, Fishman M.
Opioid use disorder and the COVID 19 pandemic: a call to sustain regulatory easements and further expand access to treatment. Subst Abus ; 41 — Adapting a low-threshold buprenorphine program for vulnerable populations during the COVID pandemic.
J Addict Med Medication treatment for opioid use disorder and community pharmacy: expanding care during a national epidemic and global pandemic. Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID pandemic. Am J Health Syst Pharm ; 78 — Considering the harms of our habits: the reflexive urine drug screen in opioid use disorder treatment.
Treatment of opioid use disorder during COVID experiences of clinicians transitioning to telemedicine. Aten Primaria ; 52 — Telemedicine-delivered treatment interventions for substance use disorders: a systematic review. J Subst Abuse Treat ; — Assessing the validity of the Australian Treatment Outcomes Profile for telephone administration in drug health treatment populations. Drug Alcohol Rev ; 39 — Mobile health clinic model in the COVID pandemic: lessons learned and opportunities for policy changes and innovation.
Int J Equity Health ; 19 Leveraging digital tools to support recovery from substance use disorder during the COVID pandemic response. Policies to improve substance use disorder treatment with telehealth during the COVID pandemic and beyond. J Addict Med ; 14 :e8—e9. Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine. Subst Abus ; 1—8. Tringale R, Subica AM. Arunogiri S, Lintzeris N. Addiction ; — Unintended consequences of the transition to telehealth for pregnancies complicated by opioid use disorder during the coronavirus disease pandemic.
Am J Obstet Gynecol ; — Changing outdated methadone regulations that harm pregnant patients. J Addict Med ; 15 — Support Center Support Center. External link. Please review our privacy policy. Address continued access to the servicesAddress the safety of the staff and the patients at the servicesContinuity of low-threshold servicesContinuity of psycho-social therapiesContinuity of pharmacological therapyMake sure the premises of the services areclean and hygienicProvide people with information on and means to protect themselves at every possible occasionSupport homeless people, including people with drug use disordersUnder no condition should a person be denied access to healthcare based on the fact that they use drugs.
The name and address of any facility other than the primary dispensing site where methadone will be dispensed either on a regular basis or on weekends, and as a service to the treatment program.
If the medical director is also the medical director for another treatment program, enclose a written justification for the feasibility of such an arrangement.
The name and state license number of all OTP personnel other than program physicians licensed by law to dispense narcotic drugs even if they are not, at present, responsible for administering or dispensing methadone at the program. These would include pharmacists, registered nurses, and licensed practical nurses. A tentative schedule showing dispensing hours, counseling hours, and hours to be worked by physicians, nurses, and counselors.
Any work to be performed away from the primary dispensing site should also be stated. The program must be open for dispensing at least six days per week. Also, describe how the dispensing hours are adequate and will ensure quality of patient care per 42 CFR 8. A description of the number of patients to be treated at operating capacity.
An affirmative statement that the treatment program will use containers for all take-home medication dispensed to outpatients with safety closures. After the request is verified, the applicant will receive an email with a username and password for use of the website.
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By not making a selection you will be agreeing to the use of our cookies. I Agree Learn More. The physician should monitor for buprenorphine-precipitated withdrawal while the patient is in the office. This is not to be confused with withdrawal from underdosing of buprenorphine, which usually occurs in the second half of the hour dosing interval. The maintenance dose may be achieved by doubling the dose each day, to a maximum of 24 mg to 32 mg. If withdrawal symptoms arise at any time during the hour dosing interval, the dose is too low and needs to be increased.
If induction occurs too slowly, the patient may prematurely terminate treatment. Therefore, it is important for the practitioner to be diligent in monitoring the patient. When converting to or from the naltrexone combination, a ratio of the buprenorphine dose may be used. When the maintenance dose is achieved, buprenorphine may be administered from every other day to 3 times weekly e.
Everyday regimens have been associated with increased withdrawal symptoms. The daily dose may be doubled for every-other-day dosing and also for thrice-weekly dosing, but Friday's dose would be 2. New patients should be advised that sublingual tablets must be dissolved under the tongue, as the medication is much less effective if swallowed.
Wetting the mouth before placing the tablets under the tongue may help them dissolve faster. Full absorption may take up to 10 minutes. Patients should refrain from smoking for 10 to 15 minutes before taking the medication, as this seems to help the tablets dissolve faster. Side effects are associated mainly with buprenorphine, since naloxone is not readily absorbed. In clinical trials, the most common adverse effects were headache, withdrawal syndrome, pain, nausea, insomnia, sweating, rhinitis, constipation, abdominal pain, flulike syndrome, and flushing.
One dangerous interaction to monitor for is the potentially fatal interaction with benzodiazepines. Compared with methadone, buprenorphine may be a safer choice in patients receiving antiretrovirals. It is well established that both methadone and buprenorphine are effective for decreasing illicit drug use.
It is worthwhile to consider the results of studies examining the efficacy of methadone versus buprenorphine. One study found less illicit heroin use with buprenorphine than with methadone, but the methadone arm had higher retention rates. Because of DATA and ongoing research on opioid dependence, pharmacists must be prepared to face an increase in the number of prescriptions being written for opioid maintenance treatment.
When presented with a new prescription, a pharmacist may visit the site www. Pharmacists must monitor and counsel patients about withdrawal symptoms and overdose possibilities. Because buprenorphine is a partial agonist, the risk of overdose is smaller, and its use in combination with naloxone further reduces the risk of intravenous abuse.
Historically, daily visits to methadone clinics have been the most frequently utilized method of treating opioid dependence, but with the current availability of sublingual buprenorphine products, more patients will be able to receive treatment in a convenient office-based setting. Figure 7. Accessed August 16, Treatment for opioid dependence: quality and access. Physician waiver qualifications. Accessed August 20, The neurobiology of opioid dependence: implications for treatment.
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