Are signs/symptoms resulting from Buprenorphine in the new patient who has been using heroin likely to be serious e.g., to the extent that referral to an Emergency Room facility might be needed?
USA Response: If a patient is using heroin when Buprenorphine is initiated, s/he might get significant withdrawal resulting in an ER visit. But again, it is not safety but physical discomfort and fear that will cause the patient to go to the ER—unless s/he has taken a dangerous dose of heroin and needs acute care for overdose. France Response: The adverse consequences, if they occur, are not life threatening. For some patients, however, the aversive experience is significant and causes them to reject continued treatment with Buprenorphine; such patients report they are allergic. Q: INDUCTION- The American Society of Addiction Medicine (ASAM) is one of only two organizations currently training in Buprenorphine treatment under authority of the U.S. Government. With regard to induction of patients beginning Buprenorphine treatment, the manual suggests the following: Patients shall be instructed . . . to abstain from any opioid use for 12-24 hours (so they are in mild withdrawal at time
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