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Opioid use disorder — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatry (outpatient management)Opioid use disorderUSMLE Step 3

A patient with fentanyl use disorder last used fentanyl 18 hours ago. They have yawning, piloerection, mydriasis, diarrhea and a Clinical Opiate Withdrawal Scale score of 13. They request treatment in the ED. What is the best next step?

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Reveal the answer and explanation

Correct answer: D — Start buprenorphine induction now and reassess withdrawal after the first dose

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

Buprenorphine is started when objective withdrawal is present. A, B and E either delay evidence-based treatment or provide an unsuitable opioid strategy. C may relieve selected autonomic symptoms but is not maintenance treatment.

Reference: SAMHSA, Practical Tools for Prescribing Buprenorphine: https://library.samhsa.gov/product/practical-tools-prescribing-buprenorphine-treating-opioid-use-disorder/pep21-06-02-002