Table 5.

Timeline for case 5

Relevant medical history and interventions A 72-year-old man who presented with chronic abdominal pain, had left a buprenorphine-naloxone (Suboxone) maintenance program in the past. He returned to treatment, thinking he would have better pain relief from buprenorphine-naloxone. The patient was getting opioids from an Internet supplier—“tapentadol 100 mg”—but the treatment team was uncertain if that was the actual medication and dose.
Date	Summaries from initial and follow-up visits	Diagnostic testing	Interventions
6/3/19	Patient had already taken his morning dose of “tapentadol.” Before administration of transdermal buprenorphine patch, there were no subjective reports of withdrawal or physical symptoms of withdrawal	None	Started use of buprenorphine transdermal patch, 10 μg/h. At night took dose of “tapentadol”
6/4/19	None	None	Continued transdermal buprenorphine patch, 10 μg/h; reduced “tapentadol” dose by half
6/5/19	Patient noticed that transdermal buprenorphine patch fell off and taped it back on. Patient reported “good” mood and denied any withdrawal symptoms; physical examination findings revealed no physical symptoms of withdrawal	None	Continued buprenorphine transdermal patch, 10 μg/h; discontinued “tapentadol”
6/6/19	None	None	Continued transdermal buprenorphine patch 10 μg/h; started buprenorphine-naloxone, 8/2 mg, sublingually
6/7/19	Patient continued to have abdominal discomfort that was treated with ondansetron (Zofran), but his opioid use stabilized	None	Removed transdermal buprenorphine patch; continued sublingual buprenorphine-naloxone, 8/2 mg daily