Buprenorphine-naloxone (Suboxone) for Opioid Use Disorder

Our March 2026 Clinical Grand Rounds will be on "Buprenorphine-naloxone (Suboxone) for Opioid Use Disorder" presented by Danise Schiliro, MD, FACP. These presentations are free and open to the public ($10 if requiring CEUs, free CEUs for Root staff). This presentation is 1.5 CEUs.

Danise is a Program Director for the Yale-Waterbury IM Residency Program at Waterbury Hospital.

Synopsis and Objectives:

During this session, we will discuss how to approach the care of a patient with an opioid use disorder (OUD). We will review medications that are commonly used to treat opioid use disorder. We will appreciate complexities of this patient population and co-morbidities that may present challenges to care​. And we will discuss the definition of harm reduction and have a conversation about it.

Questions:

1. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5) describes OUD as a problematic pattern of opioid use leading to problems or distress, with at least two of 11 criteria occurring within a 12-month period. Name 2 of these 11 criteria.

• Taking larger amounts or taking drugs over a longer period than intended.​
• Persistent desire or unsuccessful efforts to cut down or control opioid use.​
• Spending great deal of time obtaining or using opioid or recovering from its effects​
• Craving, or a strong desire or urge to use opioids​
• Problems fulfilling obligations at work, school or home.​
• Continued opioid use despite having recurring social or interpersonal problems.​
• Giving up or reducing activities because of opioid use.​
• Using opioids in physically hazardous situations such as driving while under the influence of opiates.​
• Continued opioid use despite ongoing physical or psychological problem likely to have been caused or worsened by opioids.​
• Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)
• Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

2. Name 2 differences between Buprenorphine and Methadone (i.e. Mechanism of action, mode of administration, access to these medications).

1.  The Clinical Opioid Withdrawal Symptoms (COWS) Score is used to measure objectively at least mild-mod withdrawal before initiating someone on buprenorphine therapy. Name 3 symptoms of opioid withdrawal that are measured in this score.

A: Fast heart rate, sweating, restlessness, pupil size (small), bone/joint pain, runny nose, gastrointestinal upset, tremors, yawning, anxiety, goosebumps (gooseflesh)

4. Providing this medication and education about this medication to patients with OUD, as well as their family members and friends,

reduces overdose mortality

A: Naloxone