Narrative review: buprenorphine for opioid-dependent patients in office practice.
The profile of opioid dependence in the United States is changing. Abuse of prescription opioids is more common than that of illicit opioids: Recent data indicate that approximately 1.6 million persons abuse or are dependent on prescription opioids, whereas 323,000 abuse or are dependent on heroin. Despite this prevalence, nearly 80% of opioid-dependent persons remain untreated. One option for expanding treatment is the use of buprenorphine and the buprenorphine-naloxone combination. Buprenorphine is a partial opioid agonist that can be prescribed by trained physicians and dispensed at pharmacies. This article addresses the clinical presentation of a patient with opioid dependence and describes the relatively new practice of office-based treatment with buprenorphine-naloxone. The different components of treatment; the role of the physician who provides this treatment; and the logistics of treating this growing, multifaceted patient population are also examined.
Sullivan
Lynn E
LE
Yale University School of Medicine, New Haven, Connecticut 06520-8093, USA. lynn.sullivan@yale.edu
Fiellin
David A
DA
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*; D010347:Patient Care Planning / Q000592:standards*; D010819:Physician's Role; D011320:Primary Health Care / Q000592:standards
D004338:Drug Combinations; D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone