Science & practice perspectives / a publication of the National Institute on Drug Abuse, National Institutes of Health
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Buprenorphine is a new and attractive medication option for many opioid-addicted adults and their physicians. Before initiating buprenorphine treatment, providers must be aware of such critical factors as how the medication works, its efficacy and safety profile, how it is used in opioid withdrawal as well as maintenance treatment, and how patients can best be selected, educated about buprenorphine, and monitored throughout treatment. This article reviews these important issues as well as requirements for physician and staff training and needs for additional research on this unique medication.
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A new service delivery system for the treatment of opioid dependence, called motivational stepped care, matches the intensity of counseling services to each patient's clinical progress. Adherence to a counseling schedule is reinforced through the linking of counseling attendance with the patient's methadone dispensing schedule and, ultimately, his or her ability to continue receiving treatment services. The article describes the scientific evidence supporting the major elements of the model, the model in action, and evaluations that have been conducted to date.