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SUBOXONE (Buprenorphine/Naloxone) Induction Orders

NURSING CONSIDERATIONS:

❖ DELAY INDUCTION UNTIL CLIENT HAS ABSTAINED FROM OPIATE USE FOR A MINIMUM OF 12-24 HOURS

➢ In the interim, use Clonidine (see below) as indicated

❖ Monitor withdrawal symptoms using the Clinical Opiate Withdrawal Scale (COWS)

❖ Assess client using COWS prior to each and every dose, and 1 hour after administration of each and every dose

❖ Each administration must be witnessed directly by staff

❖ Client must be advised to refrain from eating, drinking, speaking, smoking for 10 minutes while sublingual tables dissolve

❖ Staff to remain in client’s presence for 10 minutes after administration of each dose

Day 1

• Administer initial dose of 4mg/1mg Buprenorphine/Naloxone SL

• If withdrawal symptoms are not adequately relieved after 1-3 hours: administer additional 2mg/0.5mg Buprenorphine/Naloxone SL, reassess in another 1 hour

• Repeat hourly until withdrawal symptoms are adequately relieved or to a max of 12mg/3mg on Day 1

Day 2

• Ascertain whether Day 1 dose was sufficient to adequately relieve withdrawal symptoms

o If withdrawal symptoms were adequately relieved on Day 1: administer the total dose received on Day 1 (dose will be between of 4mg/1mg – 12mg/3mg Buprenorphine/Naloxone SL)

o If withdrawal symptoms were NOT adequately relieved on Day 1: administer 16mg/4mg Buprenorphine/Naloxone SL

Day 3

• Ascertain whether Day 2 dose was sufficient to adequately relieve withdrawal symptoms

o If withdrawal symptoms were adequately relieved on Day 2: administer that dose again (dose will be between 4mg/1mg – 16mg/4mg Buprenorphine/Naloxone SL)

o If withdrawal symptoms were NOT adequately relieved on Day 2: administer 20mg/5mg Buprenorphine/Naloxone SL

Day 4

• Ascertain whether Day 3 dose was sufficient to adequately relieve withdrawal symptoms

o If withdrawal symptoms were adequately relieved on Day 3: administer that dose again (dose will be between 4mg/1mg – 16mg/4mg Buprenorphine/Naloxone SL)

o If withdrawal symptoms were NOT adequately relieved on Day 3: administer 24mg/6mg Buprenorphine/Naloxone SL

Maintenance dose is achieved when client is no longer experiencing uncomfortable symptoms of Opiate withdrawal. It may be reached on any of the induction days thus induction may take LESS than four days, This maintenance dose will be the client’s daily dose moving forward unless otherwise indicated.

Clonidine Option (please check to order):

• Clonidine 0.1 mg PO TID PRN for symptoms of withdrawal PRIOR to Day 1 induction OR for precipitated withdrawal symptoms only (withhold dose if diastolic BP less than 60 mm Hg)

o Avoid use for 8hrs prior to first Buprenorphine/Naloxone dose as it may mask withdrawal symptoms and interfere with successful titration.

PRESCRIBERS must agree to (or assign a designate) to continue outpatient Opiate Agonist Therapy at conclusion of inpatient therapy.

TRIPLICATE PRESCRIPTION MUST ACCOMPANY THIS ORDER to Mary Basil House by FAX: 778-517-5609 and ORIGINAL to Cranbrook IDA Pharmacy 13-24th Ave. North. Cranbrook, BC. V1C 3H9

Physician/NPsignature:_________________________________Date/Time:_________________

After HoursPhone #:__________________________ Office/Clinic Phone#:__________________

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