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Low Dose Initiation of Buprenorphine: A Narrative Review and Practical Approach
Shawn M Cohen1, Melissa B Weimer, Ximena A Levander
1From the Program in Addiction Medicine, Section of General Internal Medicine, Yale School of Medicine (SMC, MBW, JMT, KLM); Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States (XAL); Department of Pharmacy, Massachusetts General Hospital, Boston, MA (AMP).
Low dose buprenorphine initiation offers a way to start treatment without withdrawal. This method gradually increases the dose, allowing continued use of other opioids and expanding access to care.
Area of Science:
- Addiction Medicine
- Pharmacology
Background:
- Opioid use disorder (OUD) treatment is critical.
- Traditional buprenorphine initiation can cause withdrawal.
- Contaminated drug supply increases OUD risks.
Purpose of the Study:
- To describe a low-dose buprenorphine initiation strategy.
- To provide guidance for this emerging treatment method.
Main Methods:
- Gradual dose titration of buprenorphine.
- Continued use of full opioid agonists.
- Frequent monitoring and communication.
- Pausing buprenorphine if withdrawal occurs.
Main Results:
- Low-dose initiation avoids precipitated withdrawal.
- Allows continued opioid use during induction.
- Expands eligibility for buprenorphine treatment.
Conclusions:
- Low-dose buprenorphine initiation is a viable alternative.
- Requires careful patient selection and monitoring.
- Addresses challenges of the current synthetic opioid crisis.
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