The Next Stage of Buprenorphine Care for Opioid Use Disorder

Ann Intern Med. 2018 Nov 6;169(9):628-635. doi: 10.7326/M18-1652. Epub 2018 Oct 23.


Buprenorphine has been used internationally for the treatment of opioid use disorder (OUD) since the 1990s and has been available in the United States for more than a decade. Initial practice recommendations were intentionally conservative, were based on expert opinion, and were influenced by methadone regulations. Since 2003, the American crisis of OUD has dramatically worsened, and much related empirical research has been undertaken. The findings in several important areas conflict with initial clinical practice that is still prevalent. This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment. For each area, evidence for needed updates and modifications in practice is provided. These modifications will facilitate more successful, evidence-based treatment and care for patients with OUD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Benzodiazepines / therapeutic use
  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use*
  • Central Nervous System Agents / therapeutic use
  • Counseling
  • Drug Therapy, Combination
  • Evidence-Based Medicine*
  • Humans
  • Induction Chemotherapy / methods
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / therapeutic use*
  • Opiate Substitution Treatment*
  • Opioid-Related Disorders / drug therapy*
  • Patient-Centered Care
  • Practice Guidelines as Topic
  • Recurrence
  • Substance Abuse Detection


  • Central Nervous System Agents
  • Narcotic Antagonists
  • Benzodiazepines
  • Buprenorphine