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Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report

Shannon Menard1, Archana Jhawar1

  • 1Clinical Pharmacy Specialist, Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Clinical Pharmacy Specialist, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.

The Mental Health Clinician
|November 26, 2021
PubMed
Abstract

Insights

Microdose buprenorphine induction effectively transitioned a patient from high-dose methadone with minimal withdrawal. This approach offers a promising alternative for patients on significant methadone doses.

Area of Science:

  • Pharmacology
  • Addiction Medicine
  • Clinical Psychiatry

Background:

  • Buprenorphine, a partial mu-opioid agonist, treats opioid dependence but initiation can be challenging due to withdrawal and wait times.
  • High-dose methadone stabilization presents unique hurdles for transitioning patients to buprenorphine.
  • Limited data exists on microdose buprenorphine induction for patients on methadone doses exceeding 100 mg.

Observation:

  • A 29-year-old patient on 105 mg of methadone underwent a 7-day microdose induction protocol.
  • The transition occurred within an inpatient psychiatric setting.
  • The patient reported experiencing only minimal withdrawal symptoms during the buprenorphine-naloxone initiation.

Findings:

  • Successful transition to sublingual buprenorphine-naloxone was achieved using the microdose protocol.
  • The microdose strategy minimized adverse withdrawal effects in a patient on high-dose methadone.
  • This case demonstrates the feasibility of microdose induction in this patient population.

Implications:

  • Supports the growing evidence for microdose buprenorphine induction as a viable strategy.
  • Offers a potential solution for patients stabilized on high methadone doses who struggle with traditional buprenorphine initiation.
  • Highlights the utility of microdosing in managing opioid use disorder transitions in clinical psychiatry settings.
Keywords:
OUDSUDbuprenorphinemethadonemicrodoseopioid use disordersubstance use disorder

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