Transition From Methadone to Buprenorphine Using a Short-acting Agonist Bridge in the Inpatient Setting: A Case Study

Area of Science:

• Addiction Medicine
• Pharmacology
• Clinical Pharmacy

Background:

• Methadone and buprenorphine are primary treatments for opioid use disorder (OUD).
• Buprenorphine is often preferred due to fewer drug interactions and regulatory hurdles.
• Transitioning from methadone to buprenorphine can be complicated by precipitated withdrawal.

Purpose of the Study:

• To describe a novel inpatient method for transitioning patients from methadone to buprenorphine.
• To present a safe and feasible alternative to existing methadone-to-buprenorphine transition protocols.
• To utilize readily available buprenorphine formulations and dosages.

Main Methods:

• An inpatient transition from methadone to buprenorphine was conducted over 7 days.
• A short-acting opioid agonist (hydromorphone) was used as a bridge.
• Commonly available dosages and formulations of buprenorphine were employed.

Main Results:

• The described method successfully transitioned a patient from methadone to buprenorphine.
• This approach utilized standard hydromorphone and buprenorphine products.
• The 7-day protocol aimed to minimize the risk of precipitated withdrawal.

Conclusions:

• This hydromorphone bridge method provides a viable alternative for methadone-to-buprenorphine transitions in OUD treatment.
• The described protocol offers a potentially faster and more feasible transition strategy.
• This case report serves as a template for alternative medication-assisted treatment transition protocols.