Question 2

October 16, 2019

Question:

Mr. Scott is a 47 yo gentleman you are treating for opioid use disorder with buprenorphine. Recently he has had a number of difficult life circumstances including a divorce, a demotion at work, and worsening of his chronic back pain. His last few toxicologies have shown some fentanyl and oxycodone, which are not prescribed by anyone on his care team, in addition to his buprenorphine. Evidence shows that the greatest benefit of the buprenorphine for Mr. Scott, in thinking about a harm reduction approach, is:

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Answer:

prevents relapse

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reduces illicit opioid use

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improves health

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Answer:

reduces risk of overdose death

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Explanation:

Buprenorphine is a partial opioid agonist which blocks the euphoria and sedation associated with opioid use and prevents symptoms of withdrawal. This has profound downstream effects for individuals suffering from opioid use disorder resulting in reduced relapse, illicit use, risk of overdose death, and improved overall health. All forms of MAT (buprenorphine, methadone, and naltrexone) have been shown to be more effective than non-medication treatment alone to reduce opioid use. Opioid use disorder is a chronic disease and relapse is expected, particularly if patients undergo life stressors and adverse events such as Mr. Scott. Continuing to offer buprenorphine or other MAT even in the setting of a “slip” can prevent overdose death and offers profound harm reduction even in setting of relapse.

Citation:

Korthuis PT, McCarty D, Weimer M, Bougatsos C, Blazina I, Zakher B, et al. Primary Care–Based Models for the Treatment of Opioid Use Disorder: A Scoping Review. Ann Intern Med. 2017;166:268–278. PMID: 27919103

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