Buprenorphine-Naloxone Telepsychiatry — Speaker Companion

Duration: 50 minutes | Audience: Clinical providers, fellows, residents | Materials: Presentation slides, guide handout

Slide 01: Title Slide

2 min

Speaker Notes

  • Welcome audience, establish credibility
  • Preview key statistics (66-80% overdose reduction, 83% UDS compliance)
  • Set expectation: interactive cases ahead
  • Acknowledge this is evidence-based, 2026 current
💡 Tip: Make eye contact with back row during welcome. Emphasize that tele-MAT is not "lesser than" in-person care.
→ Transition: "Today we'll cover patient selection, induction protocols, complications, and the regulatory framework that makes this possible."

Anticipated Questions

Q: Is this applicable to all practice settings? Easy

A: Yes. While regulations vary by state, the federal flexibilities through December 2025 allow telehealth buprenorphine prescribing in most settings. Key requirements: DEA registration, state licensure where patient is located, and PDMP query.

Q: Will slides be available after the session? Easy

A: Yes, PDF and interactive HTML versions will be provided via email within 24 hours. The full clinical guide is also available for download.

Slide 02: Learning Objectives

1 min

Speaker Notes

  • Read through objectives clearly
  • Emphasize practical application: "Monday morning" skills
  • Note board-relevance where applicable
→ Transition: "Let's start with why tele-MAT matters—the evidence base."

Anticipated Questions

Q: Are these CME-accredited? Easy

A: Yes, this session is approved for CME credit. Instructions for claiming credit are provided in your materials.

Slide 03: Why Tele-MAT Works

4 min

Speaker Notes

  • Emphasize the mortality data: 66-80% reduction is substantial
  • Retention rates equal/superior to in-person: addresses common skepticism
  • <1% precipitated withdrawal: safety is achievable
  • Barrier reduction: key advantage of telehealth
💡 Board Trigger: Buprenorphine's ceiling effect on respiratory depression makes it safer than full agonists for outpatient treatment.
→ Transition: "But not everyone is a candidate. Let's discuss patient selection."

Anticipated Questions

Q: What about the <1% precipitated withdrawal rate—is that with fentanyl too? Medium

A: Yes, recent large-scale studies show precipitated withdrawal rates remain <1% even with fentanyl when proper protocols are followed. Key is using appropriate induction strategies—either extended wait times with higher COWS thresholds OR micro-dosing approaches.

Q: How does tele-MAT handle urine drug screens? Medium

A: Multiple validated approaches: mail-in self-collection kits with temperature strips, video-supervised collection, and emerging DNA verification technology. Studies show 83% compliance at 30 days and 99.7% at 180 days—equal or better than in-person.

Slide 04: Patient Selection

5 min

Speaker Notes

  • Walk through ideal candidate criteria
  • Emphasize housing stability—critical for emergency planning
  • Contrast absolute vs relative contraindications
  • Note that pregnancy is NOT an absolute contraindication
⚠️ Watch for: Trainees assuming severe psychiatric illness automatically excludes from tele-MAT. Active psychosis requiring immediate intervention is the threshold.
→ Transition: "Once you've identified a suitable candidate, the initial consultation requires specific documentation."

Anticipated Questions

Q: Can pregnant patients do tele-MAT? Medium

A: Yes, pregnancy is a relative contraindication requiring enhanced monitoring, not absolute. Requires obstetric coordination, but can be managed via telehealth. Key: ensure access to emergency services, more frequent check-ins.

Q: What if they don't have reliable internet? Easy

A: Audio-only visits are permitted through December 2025 for established patients. Also consider mobile hotspot programs, library-based telehealth, or hybrid models with in-person initial visit.

Q: How do you handle benzodiazepine co-use? Hard

A: Active benzodiazepine use requires enhanced monitoring but isn't an absolute exclusion. Strategies: slower buprenorphine titration, split dosing, daily check-ins, documented informed consent about respiratory depression risk, coordinated care with prescriber of benzodiazepines, naloxone education.

Quick Reference

Key Statistic
83% UDS compliance at 30 days; 99.7% at 180 days
Critical Safety Point
Wait for COWS ≥11-13 before standard induction
Board Trap
Micro-dosing (Bernese) indicated for fentanyl users
ED Criteria
HR >140, chest pain, severe SI, patient request
Follow-up Schedule
Daily (Week 1) → 2x/week (Weeks 2-4) → Monthly

Session Timing

0:00–0:05 Introduction, Title, Learning Objectives
0:05–0:10 Evidence Base for Tele-MAT
0:10–0:18 Patient Selection Criteria
0:18–0:28 Induction Protocols (Standard + Micro-dosing)
0:28–0:38 COWS Assessment + Complications Management
0:38–0:45 Remote Monitoring + Regulatory Framework
0:45–0:50 Summary, Pearls, Q&A