title: Clinical case conference: unobserved "home" induction onto buprenorphine.
abstract: Unobserved or "home" buprenorphine induction has become a common clinical practice. Patients take the initial and subsequent doses of buprenorphine after, rather than during, an office visit. This clinical case summarizes an unobserved induction onto buprenorphine in a typical new patient. We review the core issues surrounding patient selection, feasibility, logistics, safety, and effectiveness of unobserved buprenorphine induction. Prescribers, treatment providers, policy makers, and patients should weigh the benefits of observed induction (maximum clinical supervision) with the reduced resource burden, flexibility, and comparable safety of unobserved induction.
authors.affiliation: From the Department of Population Health and Division of General Internal Medicine (JDL, JN, EG), New York University School of Medicine, New York; Friends Research Institute (FV), Baltimore, MD; and Department of Internal Medicine (DAF), Yale University School of Medicine, New Haven, CT.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lee
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.forename: Ellie
authors.initials: E
authors.lastname: Grossman
authors.forename: Frank
authors.initials: F
authors.lastname: Vocci
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine