The fragmentation of opioid use disorder care across medical specialties contributes to persistent treatment gaps, with many patients encountering healthcare systems through emergency departments, surgical services, or primary care rather than addiction specialty settings.1,2 Expanding medication for opioid use disorder access across these diverse environments requires understanding both pharmacological principles and operational realities unique to each practice setting.1,2
Buprenorphine’s pharmacology, characterized by a ceiling effect on respiratory depression and lower abuse potential compared to full agonists, makes it well-suited for initiation in non-specialty settings.3 However, practical implementation varies considerably. Emergency departments face time constraints and limited follow-up infrastructure, while surgical teams must manage perioperative pain alongside addiction treatment.1,4,5 Primary care providers often lack institutional support for longitudinal opioid use disorder (OUD) management as well as face stigma around OUD treatment as compounding barriers, despite being ideally positioned for ongoing care.6
Long-acting buprenorphine formulations may address setting-specific barriers by reducing coordination requirements between acute and longitudinal care. A patient initiated on extended-release buprenorphine during hospitalization may have a reduced risk of treatment interruption during care transitions.7 Similarly, primary care practices without the daily capacity for observed dosing may find monthly or six-month formulations operationally feasible.
Women’s health contexts present additional considerations, as preconception, pregnancy, and postpartum periods require specialized medication for OUD (MOUD) management.8 Emerging evidence on extended-release formulations in pregnant populations remains limited, warranting cautious application and vigilant monitoring.
Effective cross-setting MOUD implementation requires institutional commitment beyond individual prescriber competency. Care pathways, insurance navigation support, and warm handoffs between specialties form the essential infrastructure. As psychiatric clinicians increasingly collaborate with non-addiction specialists managing OUD, understanding how different formulations align with varied clinical workflows supports comprehensive, patient-centered treatment decision-making.
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