Microdose Induction of Buprenorphine in a Patient Using Tianeptine

Opioids and opioid alternatives are a serious threat to public health in the United States and other countries. Patients are looking to the internet increasingly as a source of opioid alternatives to self-treat addiction or other psychiatric conditions. It is imperative that patients receive proper treatment to prevent morbidity and mortality related to opioid use disorder.

We report a case of a middle-aged male with a 3-year history of tianeptine use who presented to an outpatient clinic looking for addiction treatment options after failed attempts at tapering his daily dosage of approximately 10 grams per day. The patient underwent a microdose induction of sublingual buprenorphine over a 7-day period (0.25-12 mg) while continuing tianeptine use, and self-monitored for withdrawal symptoms daily using the Clinical Opiate Withdrawal Scale. The patient was seen over the course of treatment by a board-certified toxicologist and addiction specialist on day 2, 5, 6, and 14 to ensure patient safety and treatment adherence. After 14 days of treatment, the patient was able to stop tianeptine use without any major symptoms of withdrawal, anxiety, or depression.

This case report highlights the effectiveness of buprenorphine in the treatment of opioid use disorder in a patient using tianeptine and further exemplifies the utility of buprenorphine in an outpatient setting.