84. Taking Extra Buprenorphine and Methadone84. Taking Extra Buprenorphine and Methadone
Addiction Medicine Journal Club
Drs. Sonia Del Tredici and John Keaton review a cohort study on how often patients on methadone or buprenorphine take extra doses from non-prescribed sources, and discuss who is most likely to do so. They also talk about nicotine being rebranded as a wellness product and recent FDA discussions around psychedelic treatments for mental illness.
39:21•5 Oct 2026
Extra Buprenorphine, Methadone and the Myth of ‘Wellness’ Nicotine
Episode Overview
- Around 10% of clinic visits and about one in five patients over time involved some extra-medical use of methadone or buprenorphine beyond prescribed doses.
- Higher buprenorphine doses (over 16 mg/day) were linked to greater odds of extra-medical use, while longer methadone treatment (over 6 months) was linked to less.
- Injection drug use, polysubstance use, withdrawal symptoms, depression, homelessness and recent incarceration were all associated with higher odds of taking extra MOUD.
- The hosts highlight a growing gap between wellness marketing and medical evidence, stressing that nicotine is highly addictive and not a health product.
- They call for clinicians to routinely ask patients about extra-medical MOUD use in a non-punitive way, to better understand needs and adjust treatment plans.
“Nicotine is not a health promoting substance.”
Get ready to be moved by real-life accounts of how addiction medicine actually plays out in clinics and on the streets. This episode of Addiction Medicine Journal Club focuses on something many clinicians quietly wonder about: how often do patients on methadone or buprenorphine take extra doses from outside their prescription? Dr. Sonia Del Tredici and Dr.
John Keaton walk through a cohort study of 641 adults in Baltimore with a history of injection drug use, asking how common "extra medical" methadone or buprenorphine use really is and who is most likely to do it. They quote figures like, "about 10% of visits" involving extra-medical use and note that "one in five patients during their treatment course" reported it at least once.
Sonia shares that many of her patients arrive already using street buprenorphine long term, and she jokes that sometimes she almost wants to say, "why don't you just get some extra?" when pharmacies run short. The conversation stays practical and clinic-focused. John admits, "I actually have not to date asked, are you using more or alternative medication beyond what I'm giving you?" and decides this paper will change his follow-up questions.
Sonia reflects on patients who take extra buprenorphine in response to stress or pain and worries this can train the brain to reach for more medication with every bad feeling. Between journal chat, they also tackle a media piece on the pro‑nicotine "wellness" movement, firmly stating, "Nicotine is not a health promoting substance," and laugh about cake icing dinners and Simpsons tomacco references while still stressing the seriousness of addiction.
A policy-heavy segment on the FDA’s path for psychedelic therapies raises concerns about "the wild west" if psilocybin becomes widely prescribable without structured supports. If you're a clinician working with MOUD, or just curious about how research can sharpen everyday practice, this episode might get you asking: how many of your patients are quietly taking more than what's on the script?
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