In a case of opioid use disorder treated with buprenorphine, the most appropriate next step when there is concurrent benzodiazepine use and alcohol intake is to:

• A. Increase buprenorphine to 24 mg
• B. Refer to methadone maintenance
• C. Admit to inpatient detoxification
• D. Obtain more history

Answer: (D)

When managing opioid use disorder with buprenorphine, the immediate concern is safety in the setting of co-use of benzodiazepines and alcohol. Before adjusting therapy, you need a thorough history to understand how these substances are being used: what doses, how recently, whether use is prescribed or illicit, patterns of use, prior overdoses, withdrawal symptoms, and any liver or other medical issues that affect metabolism and risk. This information guides whether the situation is stable enough to continue current buprenorphine with closer monitoring, or whether additional steps are needed (such as a taper of sedatives, safer use planning, or more supervised care).

Increasing the buprenorphine dose would not address the safety concerns posed by concurrent benzodiazepine and alcohol use and could worsen sedation or respiratory risk in the context of polysubstance use. Referral to methadone maintenance, inpatient detoxification, or other pathways might be considered later, but they depend on the detailed history and risk assessment obtained first.