PRACTICE PARTNER
or sold to others. Daily dispensing is also a powerful
motivation for stopping drug use; take-home doses can
be initiated and gradually increased when the patient
consistently reports no illicit drug use and urine drug
screens are consistently negative.
Take-home doses of a few days or a week can be
given early in treatment if daily pharmacy attendance
is difficult because of work or family obligations,
limited mobility, or lack of transportation. Take-home
doses should also be considered in patients who only
use oral opioids, who only get opioids from a single
source, and who are not using alcohol or other drugs
problematically.
Patients who have stopped using unauthorized drugs
for several months or more can attend their pharmacy
once a week for one observed dose and are dispensed
six doses medication to take home. Extremely stable
patients can pick up 2–4 weeks of medication at a time.
Urine drug screens should be done at each office visit,
either through point-of-care immunoassay strips or
by chromatography. A urine screen with unexpected
results, such as opiates or illicit drugs, should prompt a
discussion with the patient.
Patients should be seen every 1–2 weeks at the be-
ginning of treatment, and every month thereafter for
the first year. At each visit, the physician should ask
about substance use, mood, and function.
Ontario. www.cpso.on.ca
• Medical mentoring for addictions and pain. Ontario College
of Family Physicians. http://ocfp.on.ca/cpd/collaborative-
networks/mmap
• Project ECHO Ontario Pain: Chronic Pain and Opioids
www.echoontario.ca/Echo-Clinic/Chronic-Pain.aspx
• Project ECHO Ontario Pain: Mental Health and Addictions
Conclusion
www.echoontario.ca/Echo-Clinic/Mental-Health-and-
Buprenorphine is a safe and effective treatment for
opioid use disorder, and an important part of a com-
prehensive public health strategy to combat the opioid
crisis. It is considered to be the best choice for opioid
replacement therapy today and doctors are encour-
aged to seek further guidance in order to become more
comfortable prescribing it. When used appropriately
and effectively, buprenorphine can save lives.
MD
Resources
• Prescribing Drugs Policy, College of Physicians and Surgeons of
Excellent resources are available to help Ontario physi-
cians prescribe buprenorphine. The Centre for Addic-
tion and Mental Health has produced guidelines on
buprenorphine prescribing and holds an on-line and
in person course several times per year. MMAP and
Project ECHO provide long-distance clinical support.
Addictions.aspx
• Buprenorphine-assisted treatment of opioid dependence: an
online course for front-line clinicians. Centre for Addiction
and Mental Health, 2012. www.camh.ca/en/education/about/
AZCourses/Pages/BUP.aspx
• Buprenorphine/naloxone for opioid dependence: clinical
practice guideline. Centre for Addiction and Mental Health,
2011. www.cpso.on.ca/uploadedFiles/policies/guidelines/
office/buprenorphine_naloxone_gdlns2011.pdf
• Essential Clinical Skills for Opioid Prescribing. Institute for Safe
Medication Practices Canada, 2017 www.ismp-canada.org/
download/OpioidStewardship/Opioid-Prescribing-Skills.pdf
• Safe opioid prescribing and managing opioid use disorder:
A pocket reference for primary care providers. Women’s
College Hospital, October 31, 2017. www.porticonetwork.ca/
documents/324069/365598/PCP+pocket+guide/279a0ded-
d3a3-4173-9f5c-52c6190baab5
ISSUE 4, 2017 DIALOGUE
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