Although agonist medications such as buprenorphine clearly are effective for the treatment of opioid dependence, they do entail a substitute dependence on the prescribed medication to replace the prior dependence on the misused opioid. This issue should be thoroughly discussed with the patient in terms of potential risks and benefits as part of the informed consent process.
Patients and family members often are ambivalent about agonist treatment for this reason and their concerns may influence subsequent treatment choices. Possible topics of discussion include the difference between addiction and physical dependence (including an explanation of why agonist therapy is not simply “switching one addiction for another”), the likelihood of relapse with and without medication-assisted treatment, the projected duration of treatment, the potential for successfully tapering from agonist therapy at some point in the future, and the role and importance of adjunctive therapies such as counseling and peer support.
Document everything that was discussed with the patient in the patient’s QuickMD medical record (see Intial Assessment).