A 29-year-old man who drives a delivery truck presents to a family physician in a rural community with no specialized addiction clinic nearby. Two years ago he was prescribed oxycodone after a back injury; he now injects illicit fentanyl daily and has strong cravings, tolerance, withdrawal when he stops, and several failed attempts to quit. He asks to start buprenorphine and says he injected fentanyl 2 hours ago. On examination he has no yawning, tearing, rhinorrhea, piloerection, or tremor, and pupils are normal in size (Clinical Opiate Withdrawal Scale score 3). Hepatitis C antibody is positive, HIV is negative, and ECG shows a normal QTc interval. He takes no other medications and has no allergies.
| Heart rate | 78/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 122/76 mm Hg |
Question 1 of 18
Which one of the following is the most appropriate first-line treatment for this patient's opioid use disorder?
Select 1. (0 / 1 selected)
Tip: right-click an answer (or press and hold on a phone) to strike it out. Drag over the question text to highlight it.