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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Dec 9, 2019

How to initiate buprenorphine like a pro. Treating people with Opioid Use Disorder can be the most rewarding part of your practice!  Get comfortable with counseling and pharmacotherapy for OUD with tips from Dr. Michael Fingerhood, Associate Professor of Medicine at Public Health at Johns Hopkins.  We review building a therapeutic relationship with people with substance use disorders, the differences between the three FDA-approved medications for opioid use disorder (buprenorphine, methadone and extended-release naltrexone), and the nitty-gritty of prescribing buprenorphine.

ACP members can claim CME-MOC credit at (CME goes live at 0900 ET on the episode’s release date). 

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  • Written and Produced by: Justin Berk, MD MPH MBA, Joseph “Seffy” Muller MD
  • Infographic: Hannah R Abrams and Justin Berk MD, MPH, MBA
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Justin Berk, MD MPH MBA
  • Editor: Matt Watto MD, FACP (written materials), Clair Morgan at (audio)
  • Guest: Michael Fingerhood MD

Time Stamps

  • 00:00: Introduction
  • 04:40: Guest introduction & questions (great stories about addiction)
  • Picks of the Week*: Papillon (film) and Papillon (book) per Dr. Fingerhood; Miami Connection (film) per Stuart, Watto and Paul; Use GREPMED as “the Pinterest of medical education”, per Dr. Justin Berk; ASAM Handbook of Addiction Medicine by Dr. Fingerhood and Dr. Darius Rastegar; Bup App (from Yale School of Medicine)
  • 16:45: How to approach someone with addiction looking for help
  • 20:00: Choosing between methadone and buprenorphine
  • 24:15: Different formulations of buprenorphine
  • 26:45: Coverage and costs of buprenorphine
  • 28:20: Safety considerations of buprenorphine
  • 33:40: How to divide buprenorphine films for specific dosing
  • 35:00: Discussion of buprenorphine diversion
  • 36:20: Home initiation of buprenorphine 
  • 40:00: Use of urine toxicology screens and addressing concurrent use
  • 41:00: Initiation of buprenorphine in patients actively using
  • 42:30: How to address precipitated withdrawal
  • 45:00: Treating chronic pain and transitioning to buprenorphine
  • 47:00: Treating acute pain for patients on buprenorphine
  • 51:00: Dosing of buprenorphine
  • 52:15: Perceived barriers to buprenorphine (e.g. counseling resources, “trading addiction”)
  • 57:10: Historical context of opioid use disorder
  • 60:00: Take home points
  • 62:40: Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my links and buy something we earn a (very) small commission, yet you don’t pay any extra.


Dr. Fingerhood reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 


Fingerhood M, Berk JL, Muller J, Williams PN, Brigham SK, Watto MF. “#187 Buprenorphine 2.0: Managing Opioid Use Disorder for the Generalist”. The Curbsiders Internal Medicine Podcast. December 9, 2019.