Community: Primary Care
Medication: Buprenorphine
Primary Care MAR Intake and Assessment
Watch an experienced IL provider describe the intake and assessment protocols and patient materials that are used where she works.
Primary Care
Intake & Assessment

MAR Provider
If DAST-10 warrants, talk with the patient about their needs and instruct them on MAR Options to help them make an informed decision.

MAR Provider
If patient is ready for buprenorphine initiation,
- Complete labs (UDS, CBC, CMP, TSH, Hepatitis Panel, HIV and TB).
- Have patient sign Consent for Buprenorphine- Naloxone treatment form.
- Discuss home vs. in-office initiation.
Resources
Click to download.
Primary Care MAR Home Initiation
Watch an experienced IL provider describe the initiation protocols and patient materials that are used where she works.
Primary Care
Home Initiation
Pre-Initiation
Initiation Day 1

Nurse / Patient
Contact the patient during the first day of initiation to provide support and answer questions.
Initiation Day 2 and Beyond

Patient
On Day 2, patient takes 8 mg dose in the morning and assesses withdrawal symptoms over the day using the SOWS. Patient may increase daily dose to 12-16 mg before follow-up appt. on Day 5.
Primary Care
Home Initiation
Pre-Initiation

MAR Provider
Via handouts, teach SOWS and review how patient will take 4 mg Buprenorphine next morning when SOWS>15 (moderate withdrawal) and then 4 mg doses every hour until Pre-Initiation SOWS<6. (Max = 12 mg)

Case Manager
Co-develop a plan to help patient refrain from using that night and provide naloxone.
Initiation Day 1

Nurse / Patient
Contact the patient during the first day of initiation to provide support and answer questions.
Initiation Day 2 and Beyond

Patient
On Day 2, patient takes 8 mg dose in the morning and assesses withdrawal symptoms over the day using the SOWS. Patient may increase daily dose to 12-16 mg before follow-up appt. on Day 5.
Resources
Click to download.
More Information
Click to download.
Primary Care MAR In-Office Initiation
Watch an experienced IL provider describe the in-office initiation protocols and patient materials that are used where she works.
Primary Care
In-Office Initiation
Pre-Initiation
Start

Nurse
Take patient’s vitals and administer COWS.

MAR Provider
If COWS >12, administer 4 mg buprenorphine.
After 1 hour, administer another 4 mg dose every hour until COWS <5.
After 2 Hours

MAR Provider
Once COWS <5, give 4 mg dose to take home that night should withdrawal symptoms return. (Day 1 Max = 16 mg)

Nurse
Discharge patient with 8 mg buprenorphine AM & 4-8 mg buprenorphine PM (based on SOWS) for next 2 days.
Set up appt. in 3 days.
Primary Care
In-Office Initiation
Pre-Initiation

MAR Provider

Case Manager
Co-develop a plan to help patient refrain from using that night and provide naloxone.
Start

Nurse
Take patient’s vitals and administer COWS.

MAR Provider
If COWS >12, administer 4 mg buprenorphine.
After 1 hour, administer another 4 mg dose every hour until COWS <5.
After 2 hrs

MAR Provider
Once COWS <5, give 4 mg dose to take home that night should withdrawal symptoms return. (Day 1 Max = 16 mg)

Nurse
Discharge patient with 8 mg buprenorphine AM & 4-8 mg buprenorphine PM (based on SOWS) for next 2 days.
Set up appt. in 3 days.
Resources
Click to download.
- COWS
- SOWS
- Naloxone Patient Flyer
- Initiation process (for well-resourced office)
- Printable Flowchart – PC Office Initiation (smaller)
- Printable Flowchart 2 – PC Office Initiation (larger)
Primary Care MAR Stabilization and Maintenance
Watch an experienced IL provider describe the stabilization and maintenance protocols and patient materials that are used where she works.
Primary Care
Stabilization & Maintenance
Stabilization Months 1-3

MAR Provider / Nurse
During weekly (Mo. 1) and bi-weekly (Mos. 2-3) appts, we provide follow-up and peer support to:
1. Address cravings (YOCS) & other substance use.
2. Increase daily buprenorphine dose if needed.
3. Treat concurrent pain issues.
4. Treat symptoms of anxiety and insomnia.
5. Address social determinants of health.
Maintenance After 3 Months
During monthly appts, we work with the patient to:
1. Continue to assess and address cravings.
2. Assess stability, coping with stress without relapse, and return of function in relationships and work.
3. Encourage disclosure of any potential trauma issues or behavioral health issues.

Positive Drug Screens
If the patient ever presents with a positive substance use test, we help problem solve this use to identify what triggered the patient to use and how to address these triggers in the future, all the while emphasizing that relapses are not uncommon.
Primary Care
Stabilization & Maintenance
Stabilization Months 1-3

MAR Provider / Nurse / Peer Recovery Support Coach
During weekly (Mo. 1) and bi-weekly (Mos. 2-3) appts, we provide follow-up and peer support to:
- Address cravings (YOCS) & other substance use.
- Increase daily buprenorphine dose if needed.
- Treat concurrent pain issues.
- Treat symptoms of anxiety and insomnia.
- Address social determinants of health.
Maintenance After 3 Months
During monthly appts, we work with the patient to:
- Continue to assess and address cravings.
- Assess stability, coping with stress without relapse, and return of function in relationships and work.
- Encourage disclosure of any potential trauma issues or behavioral health issues.

Positive Drug Screens
If the patient ever presents with a positive substance use test, we help problem solve this use to identify what triggered the patient to use and how to address these triggers in the future, all the while emphasizing that relapses are not uncommon.
Resources
Click to download.