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Rapid Transition From Methadone to Buprenorphine Utilizing a Micro-dosing Protocol in the Outpatient Veteran Affairs
Joao P De Aquino1, Christopher Fairgrieve, Sukhpreet Klaire
1Department of Psychiatry, Yale University School of Medicine, New Haven, CT (JPD, GG-V); U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT (JPD, GG-V); Center for Addiction and Mental Health, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada (CF); British Columbia Centre on Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada (SK).
Objectives:
Alternative transition protocols from methadone to buprenorphine in the treatment of opioid use disorder (OUD) are needed to reduce the risk of precipitated withdrawal and opioid use during induction.
Methods:
Case report (n = 1).
Results:
One patient with OUD underwent a rapid microinduction outpatient protocol that did not cause precipitated withdrawal or require preceding taper before cessation of methadone. The induction was carried out safely in the outpatient setting.
Conclusions:
This report provides a patient-centered approach demonstrating feasibility and cost-effectiveness of rapid transition to buprenorphine in the US outpatient psychiatry setting. Barriers to adherence to opioid agonist therapy may be reduced using this protocol.
