If a patient’s withdrawal symptoms are somewhat worse after an initial buprenorphine dose, how should he be managed?

When a patient's withdrawal symptoms worsen after receiving an initial dose of buprenorphine, the most appropriate management strategy is to provide an additional dose of buprenorphine/naloxone. This approach aligns with the understanding of buprenorphine as a partial agonist that can alleviate withdrawal symptoms effectively when an appropriate dose is administered.

Using an additional dose can help to stabilize the patient by further binding to the opioid receptors in the brain, mitigating withdrawal symptoms more effectively, and reducing cravings for opioids. The combined formulation of buprenorphine with naloxone also serves to prevent misuse, as naloxone counteracts the euphoric effects of opioid use.

Other management options may not address the patient's immediate needs effectively. Simply sending the patient home without further intervention does not provide necessary relief from withdrawal symptoms. Increasing the dose significantly could lead to increased side effects or precipitate withdrawal, especially if the initial dose was not adequate, and might not be warranted without assessing the patient’s specific situation further. Providing only comfort medications may help alleviate some symptoms, but it does not offer the effective treatment that buprenorphine provides in the context of opioid withdrawal management.