Bupe Interruption

After admitting a buprenorphine maintenance patient to hospital a reasonable and prudent (standard of care) practitioner will make a reasonable attempt to coordinate with the outpatient buprenorphine prescriber by telephone and resume maintenance prior to discharge unless clearly contraindicated. The same should probably apply after incarceration and release of such a patient.

Recently, a buprenorphine maintenance patient in my practice was admitted to hospital for surgery. No one from the hospital staff attempted to contact me to coordinate treatment, and my attempts to do so yielded minimal results until it was too late. By the time the patient was ready for discharge the plan presented to me suggested likely discharge on full agonist opiates with no consideration of resuming buprenorphine or the serious potential consequences of providing an unsupervised opiate addict a prescription for opiates . The patient still had buprenorphine from the last prescription at home. The inpatient team could have easily foressen the danger of relapse or unsupervised induction.

I fear that this substandard practice may reflect prejudice against patients suffering from addictive disorders on the part of hospital and penal system physicians. The daunting over-regulation of this near miraculous treatment contributes.

In my opinion someone from the hospital team or jail medical service should always attempt to contact the buprenorphine prescriber as soon as possible after admission or incarceration, to begin discharge planning. Shame on the outpatient physician who neglects to respond. I understand that often buprenorphine can be continued even when surgery or the injury or illness may require temporary added analgesia. If the inpatient team believes they must discontinue buprenorphine, every hospital and jail medical service should have a waivered physician who can supervise re-induction with buprenorphine prior to discharge.

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