Pharmacists Guide Patients to Manage Opioid‑Related Adverse Effects

Buprenorphine has become a cornerstone of medication-assisted treatment for opioid use disorder (OUD), offering patients a safer path away from heroin and prescription painkillers. Yet even as its use has expanded in primary care clinics, community health centers, and addiction programs across the country, many patients still struggle with the everyday realities of staying on the medication, which can include uncomfortable adverse effects, uncertainty about how to take it correctly, and gaps in basic counseling about what to expect.

Alisha Nicks West, PharmD, BCPP, clinical staff pharmacist at The Menninger Clinic, discusses her clinical pearls that can help a patient’s experience on buprenorphine. Rather than focusing solely on dose adjustments or additional prescriptions, she discusses practical, lifestyle-based strategies that clinicians can teach in a few minutes—but that can significantly improve adherence and quality of life.

Constipation, for instance, is one of the most common and persistent problems with any opioid, and buprenorphine is no exception. West explains how simple steps—such as emphasizing a fiber-rich diet, adequate hydration, and regular physical activity—should be part of every buprenorphine counseling session, with clear guidance on when to escalate to over-the-counter options like stool softeners under medical supervision.

Nausea is another barrier that can quietly undermine treatment. Timing buprenorphine doses around meals, she notes, can reduce this adverse effect while still preserving the medication’s effectiveness, as long as patients understand when and how close to eating they should take their tablets or films.

Perhaps most overlooked, however, are the oral health risks. As buprenorphine formulations dissolve in the mouth, they can expose teeth and gums to repeated acidity. Our expert outlines straightforward oral-health counseling—rinsing with water after dosing, delaying toothbrushing for at least an hour, and maintaining regular dental visits—that can protect patients from preventable damage and help them stay on a medication that, for many, is life-saving.

“It’s important for a patient who is taking buprenorphine by mouth to take some water,” she said. “Take a swig of water after they take the medication, rinse it out, and of course, want to make sure that the tablet or the film has dissolved first before we do this water".”