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Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study

Jessica Moe1,2, Katherin Badke3, Megan Pratt4

  • 1Department of Emergency Medicine University of British Columbia Vancouver British Columbia Canada.

Journal of the American College of Emergency Physicians Open
|January 4, 2021
PubMed
Abstract

Insights

Emergency department buprenorphine/naloxone initiation is feasible using standard or microdosing take-home packages. A randomized controlled trial is acceptable to patients with opioid use disorder, suggesting potential for wider implementation.

Area of Science:

  • Emergency Medicine
  • Addiction Medicine
  • Pharmacology

Background:

  • Emergency department (ED) initiation of buprenorphine/naloxone can prevent opioid overdose.
  • Microdosing is a novel buprenorphine induction method that may overcome barriers associated with precipitated withdrawal.
  • Standard induction requires patients to be in withdrawal, which can deter treatment initiation.

Purpose of the Study:

  • To evaluate the feasibility of an ED-initiated buprenorphine/naloxone program.
  • To assess the acceptability of providing take-home standard-dosing and microdosing packages.
  • To determine the feasibility of randomizing patients to either standard or microdosing interventions.

Main Methods:

  • Broad screening of adult patients in a large, urban ED for opioid use disorder.
  • Phase 1: Consecutive patients received 3-day standard-dosing or 6-day microdosing packages.
  • Phase 2: Patients were randomized to standard or microdosing, with attempted 7-day telephone and 30-day in-person follow-ups.

Main Results:

  • 94 patients with opioid use disorder were identified out of 3954 screened ED patients.
  • 68 patients were enrolled, with 21 receiving standard dosing and 25 receiving microdosing.
  • 30-day follow-up rates were 32.6%, with 23.8% on standard dosing and 32.0% on microdosing remaining on opioid agonist therapy.

Conclusions:

  • ED-initiated buprenorphine/naloxone programs using take-home standard and microdosing packages are feasible.
  • The study population found randomization to be acceptable, supporting future randomized controlled trials.
  • These findings suggest a viable strategy for increasing access to medication for opioid use disorder in the ED setting.
Keywords:
Bernese methodbuprenorphinedrug overdoseemergency service hospitalmicrodosingmicro‐inductionnaloxone drug combinationopiate substitution therapyopioid addictionopioid‐related disorders

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