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However, some patients feel like it helps their symptoms, it helps them feel more

In other instances, continuity of treatment could be suggested because the weight is to be maintained

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Which makes it surprising when you hear that B12 deficiency is relatively common

I would give proper loading doses of buprenorphine, followed by the usual adjuncts if needed (clonidine being the most relevant here, but also ondansetron, hydroxyzine, benzos, as appropriate)