Lewis Nelson: The Art and Science of Buprenorphine MAT Induction

Lewis S. Nelson, MD, is Board Certified in Emergency Medicine, Medical Toxicology, and Addiction Medicine. Dr. Nelson is the Professor and Chair of the Department of Emergency Medicine and the Chief of the Division of Medical Toxicology. His career includes pivotal roles in the American Board of Emergency Medicine, the Accreditation Council for Continuing Medical Education, and the Association of Academic Chairs in Emergency Medicine.<br /><br />In this conversation, we delve into the pressing issue of opioid use disorder and the novel strategies employed to treat it. Buprenorphine induction forms the cornerstone of our discussion. Dr. Nelson discusses the application of techniques such as micro-dosing and macro-dosing and how they are shifting paradigms in opioid use disorder treatment. We also navigate the pros and cons of these innovative solutions, and how they outperform older induction methods, particularly in an era where fentanyl—a lipophilic opioid that tends to be stored in fat cells—dominates the street opioid landscape.<br /><br />Dr. Nelson, with his wealth of experience as a consultant to various national organizations such as the CDC, FDA, and DHS, as well as an editor of the acclaimed textbook Goldfrank's Toxicologic Emergencies, brings unparalleled insight into these complex discussions. Moreover, his first-hand experience providing direct clinical care to patients in the Emergency Department, coupled with his senior consultancy role with the New Jersey Poison Information &amp; Education System, ensures a nuanced and patient-centric perspective on this complex issue.<br /><br />From understanding the maximization of buprenorphine's agonist effect in replacing potent opioids like fentanyl to examining the challenges of managing precipitated withdrawal, this episode offers an in-depth exploration of the latest strategies in combating opioid addiction. Dr. Nelson’s insights highlight the need for a complete transition concept in opioid substitution, the varying success rates of different medications