When was your last methadone dose?"Well, I haven't been on methadone officially for about a year. But if I can't get oxy's, I buy a bit of methadone from a guy around here. I think it's 40 mg. I took some last week." You tell him that for the induction day he will have to be in moderate withdrawal to safely receive the initial dose of buprenorphine/naloxone; with full-agonist opioids present, there is a high risk of a precipitated withdrawal when buprenorphine is administered. If he use methadone, he will have to wait several days (depending on the dose of methadone) to reduce the risk of precipitated withdrawal occuring on buprenorphine induction because of the long acting nature of methadone. For the oxycodone-controlled release, he will have to abstain for a minimum of 16 hours, probably more. What else do you want to ask him? |
Map: Sam (CAMH ODT Core Course) (304)
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