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A Neuropharmacological Model to Explain Buprenorphine Induction Challenges
Mark K Greenwald1, Andrew A Herring2, Jeanmarie Perrone3
1Department of Psychiatry and Behavioral Neurosciences, School of Medicine, and Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI.
Annals of Emergency Medicine
|August 8, 2022
Summary
Novel buprenorphine induction strategies for opioid use disorder are emerging. A new model explains how prior opioid properties influence buprenorphine
Area of Science:
- Pharmacology
- Addiction Medicine
- Emergency Medicine
Background:
- Buprenorphine induction for opioid use disorder (OUD) is increasingly used in emergency settings.
- High-potency synthetic opioids necessitate novel induction strategies.
- Current methods lack theoretical and empirical guidance.
Purpose of the Study:
- To propose a neuropharmacologic working model for buprenorphine induction.
- To guide clinicians in optimizing buprenorphine induction strategies.
- To address challenges posed by chronic fentanyl and other drug exposures.
Main Methods:
- Review of clinical studies on buprenorphine induction.
- Development of a neuropharmacologic working model.
- Analysis of factors influencing induction success.
Main Results:
- Buprenorphine induction success is a nonlinear outcome.
- Key factors include initial opioid balance and prior opioid's "ALE value" (mu-opioid-receptor affinity, lipophilicity, intrinsic efficacy).
- Model aids in understanding divergent induction strategies (macrodosing vs. microdosing).
Conclusions:
- A proposed neuropharmacologic model clarifies buprenorphine induction dynamics.
- Understanding prior opioid properties is crucial for tailoring induction.
- This framework supports optimized patient induction experiences in OUD treatment.
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