More Than a Substitute: The Truth About BuprenorphineMore Than a Substitute: The Truth About Buprenorphine
Drug Diversion Insights with Terri Vidals
Terri Vidals and pharmacist Jef Bratberg talk frankly about buprenorphine, challenging common myths and outlining practical, evidence-based approaches to treatment. The discussion touches on recovery, pain management, stigma and access, all through a patient-centred lens.
42:08•9 Sept 2026
More Than a Substitute: Straight Talk on Buprenorphine and Recovery
Episode Overview
- Medications for opioid use disorder, including buprenorphine, should be offered as the foundation of care, with counselling added when accessible and desired by the patient.
- Buprenorphine is a safer opioid that occupies brain receptors, preventing withdrawal and reducing overdose risk, and should not be dismissed as merely substituting one drug for another.
- Hospitalised patients on buprenorphine should usually remain on it, with doses adjusted or split for pain, and short-acting opioids used carefully when necessary.
- Stopping buprenorphine because of positive drug tests can remove a life-preserving treatment; instead, clinicians should explore what the other substance use reflects and keep supporting the patient.
- Pharmacy refusal to stock buprenorphine, often linked to stigma and policy constraints, creates serious barriers to treatment and calls for system-level and individual advocacy.
“It's really important to talk to folks as humans, so that they have medications that literally allow them to be alive the next day.”
Curious about how others navigate their sobriety journey? This conversation zeroes in on buprenorphine and separates fact from fiction for anyone working with opioid use disorder in healthcare settings. Clinical professor and pharmacist Jef Bratberg joins host Terri Vidals to talk through the practical realities of buprenorphine. You’ll hear how Jef’s career moved from infectious disease and critical care into public health, policy and overdose prevention, shaped in large part by life-saving medicines like naloxone and buprenorphine.
The chat tackles a big question straight away: does buprenorphine only “count” as recovery if it’s combined with counselling? Jef explains that the strongest evidence supports medications first, pointing out that buprenorphine “reduces death from overdose and reduces death from any cause,” while counselling is an important extra if the patient wants and can access it. They also take on the common accusation that buprenorphine is just swapping one opioid for another.
Jef flips that idea, arguing that occupying brain receptors with “the safest opioid, which is buprenorphine” is a deliberate, protective treatment strategy, not a failure of recovery. For hospital and clinic staff, the episode spends valuable time on pain management for patients already on buprenorphine. You’ll hear why stopping the medicine during admission can be harmful, how doses can be adjusted or split for acute pain, and when short-acting opioids can be layered on safely.
Jef and Terri don’t shy away from thorny issues: difficulty tapering off buprenorphine, drug testing in treatment programmes, pharmacy refusal to stock the medicine, and the heavy weight of stigma. One key message runs throughout: “We don’t remove the foundation from a house,” even if a patient is still using other substances. If you work with people who use drugs—or care about someone who does—this episode offers straight-talking, evidence-based reassurance that medication-supported recovery is real recovery.
How might these insights shape the way you think about treatment and support?
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