Do you know David Cisewski?  He’s incredible and he’s written an incredible review on buprenorphine ( that I’d like to tell you all about.
Buprenorphine marketed as Suboxone (but soon to be generic) is a mu-opioid receptor partial agonist that will fulfill cravings for opioids and suppress withdrawal symptoms, but also has a “ceiling effect” that makes abuse difficult.
How do you dose it?  Dosing in a withdrawing patient can be quite high to stave off withdrawal, while still avoiding side effects and intoxication.  But keep in mind that Buprenorphine will induce withdrawal in a patient who is currently “high.”
Some folks, including Reuben Strayer, have endorsed prescribing Buprenorphine for 2-3 days as a bridge to rehab or PCP follow up.  A certification is needed in order to prescribe, but some EDs are encouraging.   According to NY State DOH (, opioid-related deaths are on the rise.  Should we start prescribing Buprenorphine?
For more sweet tweets follow David @Dhcisewski and @painprofile