Micro-dosing Intravenous Buprenorphine to Rapidly Transition From Full Opioid Agonists
Ashish P Thakrar1, Lindsay Jablonski, Jessica Ratner
1Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (APT); Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD (LJ); Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (JR); Johns Hopkins University School of Medicine, Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (DAR).
Journal of Addiction Medicine
|March 24, 2021
Summary
Initiating buprenorphine for opioid use disorder can be challenging. A novel micro-dosing approach using intravenous buprenorphine successfully transitioned patients without precipitated withdrawal.
Area of Science:
- Pharmacology
- Addiction Medicine
- Clinical Therapeutics
Background:
- Initiating buprenorphine for opioid use disorder (OUD) is often complicated by the risk of precipitated withdrawal, especially when transitioning from methadone or using opioid analgesia.
- Standard buprenorphine initiation methods can be difficult in hospital settings due to formulation and dosing limitations.
- Low-dose initiation, or micro-dosing, presents an alternative strategy to mitigate withdrawal risks.
Purpose of the Study:
- To describe a novel method for micro-dosing buprenorphine using an intravenous formulation.
- To evaluate the feasibility of this approach in patients with OUD transitioning from methadone and those requiring postoperative opioid analgesia.
Main Methods:
- A novel micro-dosing protocol utilizing intravenous buprenorphine was developed.
- Two case studies are presented: one patient on methadone maintenance and another requiring postoperative opioid analgesia.
- Patients received concurrent full-agonist opioids during the buprenorphine initiation phase.
Main Results:
- The intravenous micro-dosing approach allowed for successful transition to buprenorphine in both patients.
- No instances of precipitated withdrawal were observed during the initiation period.
- This method offers a potential solution for buprenorphine initiation in inpatient settings.
Conclusions:
- Intravenous buprenorphine micro-dosing is a viable and safe strategy for initiating treatment in patients with OUD.
- This novel approach circumvents limitations associated with traditional buprenorphine formulations in hospital environments.
- Further research is warranted to explore the broader applicability of this method.
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