Buprenorphine Algorithm for Uncomplicated Opioid Withdrawal - ACEP Opioids Clinical Policy



Assess Withdrawal Severity - Objective signs and Clinical Opiate Withdrawal Scale (COWS)

Moderate to severe (COWS ≥ 8) → Give buprenorphine 4-8 mg SL based on severity of withdrawal

Re-assess after 30-60 min Is clinical withdrawal present? Administer Additional Buprenorphine → 8-24 mg SL (Target 16 mg SL total for most patients)



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