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Opioid use disorder — ABIM Board MCQ

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ModerateGeneral Internal MedicineOpioid use disorderABIM Board

A 42-year-old uses fentanyl daily, has had two nonfatal overdoses and wants medication treatment. He has objective mild opioid withdrawal in clinic and no severe hepatic disease. What is the most appropriate next step?

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Correct answer: B — Initiate buprenorphine using an standard withdrawal-guided induction plan

The best answer is “Initiate buprenorphine using an standard withdrawal-guided induction plan”. Buprenorphine reduces illicit opioid use and overdose risk and can be initiated when objective withdrawal is present using a suitable protocol. Benzodiazepines do not treat the disorder and add respiratory risk, abstinence is not a prerequisite for care, naltrexone requires an opioid-free interval, and relapse risk is a reason to retain—not dismiss—the patient.

Reference: SAMHSA Buprenorphine Quick Start Guide: https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf