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Common Questions About Buprenorphine Treatment for Opioid Use Disorder

Jeffrey D. Tiemstra, MD

American Family Physician. 2025;111(4):330-336.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Related Letter to the Editor: Buprenorphine-Naloxone Safe in Pregnancy

Related Letter to the Editor: Buprenorphine Initiation in the Era of Fentanyl

Buprenorphine is a highly effective treatment for opioid use disorder, with a treatment retention rate of more than 50% at 1 year and substantially less risk of respiratory depression compared with methadone. Based on its effectiveness and safety profile, buprenorphine was recently made available to all physicians with Schedule III authority. Physicians should screen adult patients with a validated tool and offer buprenorphine to those with moderate or severe opioid use disorder. Doses should be titrated quickly to fully suppress cravings and withdrawal symptoms, typically 16 to 32 mg/day. Once patients are stabilized, they should have follow-up appointments every 1 to 3 months. Counseling or behavior therapy is not necessary for success and should be offered based on each patient’s needs and preferences. Regular urine drug testing helps identify patients who may benefit from more intense treatment or other options; any unexpected test results should not be a primary reason for treatment termination. Buprenorphine is maintenance treatment for a chronic disease and should be continued for as long as it is beneficial. Relapse rates after discontinuation are lower in patients who complete 1 year of treatment, and they continue to decline with longer treatment duration.

JEFFREY D. TIEMSTRA, MD, is a family physician at Aurora Health Care, Paddock Lake, Wisconsin, and clinical adjunct professor of family medicine at the University of Wisconsin-Madison School of Medicine and Public Health.

Address correspondence to Jeffrey D. Tiemstra, MD, at jeffrey.tiemstra@aah.org.

Author disclosure: No relevant financial relationships.

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