Microdose Induction of Buprenorphine in a Patient Using Tianeptine

Area of Science:

• Addiction medicine
• Pharmacology
• Toxicology

Background:

• Opioid use disorder (OUD) and the misuse of opioid alternatives pose significant public health challenges globally.
• Patients increasingly seek internet-sourced alternatives for self-treating addiction or psychiatric conditions, necessitating effective treatment strategies.
• Preventing morbidity and mortality associated with OUD requires accessible and proper patient treatment.

Observation:

• A case report details a middle-aged male with a 3-year history of high-dose tianeptine use (approx. 10 grams/day).
• The patient sought outpatient addiction treatment after unsuccessful tapering attempts.
• He underwent a 7-day microdose induction of sublingual buprenorphine (0.25-12 mg) while continuing tianeptine, monitoring withdrawal with the Clinical Opiate Withdrawal Scale.

Findings:

• The patient successfully ceased tianeptine use after 14 days of buprenorphine treatment.
• No major withdrawal symptoms, anxiety, or depression were reported during the treatment period.
• The patient received consistent monitoring from a board-certified toxicologist and addiction specialist.

Implications:

• This case report demonstrates the efficacy of buprenorphine for treating tianeptine use disorder.
• It highlights the successful application of buprenorphine microdose induction in an outpatient addiction treatment setting.
• Further research into buprenorphine's utility for novel substance use disorders is warranted.