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- Page navigation anchor for RE: Primary care management of opioid use disorders: Abstinence, methadone or buprenorphine-naloxone?RE: Primary care management of opioid use disorders: Abstinence, methadone or buprenorphine-naloxone?
We thank the authors Srivastava, Kahan, and Nader (1) for this comprehensive review of the available treatments for opioid use disorder, and for emphasizing the importance of accessibility of pharmacotherapy in the primary care setting. As noted by the authors, opioid use disorder has a significant public health impact in terms of morbidity and mortality, and it is essential that eligible patients are offered opioid agonist therapy given the high risk of relapse and overdose associated with abstinence-based treatment.
The authors propose that methadone should be recommended over buprenorphine-naloxone for injection opioid users with the rationale that a full opioid agonist may be more effective in relieving withdrawal symptoms and promoting treatment retention than a partial opioid agonist. In our clinical settings, however, we have had success in treating patients who inject opioids with buprenorphine-naloxone. Individuals who do not respond to optimized doses buprenorphine-naloxone in the office-based setting are typically offered methadone or referred to a higher level of care depending on their specific needs. Based on our clinical experience and recent literature, we would like to advocate for the role of buprenorphine-naloxone as another first line treatment option for injection opioid users.
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There are limitations in using route of opioid use to guide clinical decision-making when offering treatment for opioid use disorder. There is little data comparing...Competing Interests: None declared.