It is generally problematic to continue to use marijuana or abuse alcohol when beginning treatment for an opiate use disorder. From the harm reduction perspective, I have a degree of tolerance because for many patients who are in a dangerous situation with opioids having them enter treatment for opioids could be life or death while using marijuana is not a life threatening drug. However if patients are completely unwilling to discuss their particular use of alcohol and marijuana and consider changes, this is a red flag which suggests that more intensive treatment approach will be necessary.
No we don’t have to have those things to start treatment. For patients in dire situations, having them delay treatment to first get the lab work done would possibly lose the patient to their continued opiate abuse. Product literature says that getting liver enzymes is recommended. Is it essential? No. Some patients don’t have the money for these additional tests and trying to get these tests done would be problematic.
When someone is coming in for an induction, the assumption is that they are coming in with significant withdrawal. I don’t think they should be driving to the office if they’re that sick. So they’re at risk for that reason alone. People generally feel better by the 2nd or 3rd dose, but not everybody has the same reaction. Some people get energized from buprenorphine, some get sedated. So I think that it is a wise decision when you are giving an induction to require that they have someone drive them to and from the clinic.
