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48-hour Induction of Transdermal Buprenorphine to Sublingual Buprenorphine/Naloxone: The IPPAS Method

Pouya Azar1, James S H Wong, Nickie Mathew

  • 1From the Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, British Columbia, Canada (PA, JSHW, NM); Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (PA, NM); Addictions and Concurrent Disorders Research Group, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (JSHW, RMK); BC Mental Health and Substance Use Services, Provincial Health Services Authority, British Columbia, Canada (NM); University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland (MV); Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (JP); Highland Hospital-Alameda Health System, Department of Emergency Medicine, University of California, San Francisco, California (AAH); British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada (JSGM); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (JSGM); Department 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, Michigan, (MKG); and Pharmacokinetics Modeling and Simulation Laboratory, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (AM).

Journal of Addiction Medicine
|September 23, 2022
PubMed

Buprenorphine is an effective medication for the treatment of opioid use disorder. However, the traditional method of buprenorphine induction requires a period of abstinence and the development of at least moderate withdrawal, which can be barriers in starting treatment. We present the case of a hospitalized patient with opioid use disorder using unregulated fentanyl, who underwent a transdermal buprenorphine induction over 48 hours to initiate sublingual buprenorphine/naloxone on the third day. The patient experienced minimal levels of withdrawal and did not experience precipitated withdrawal. The ease of use of this novel induction method over previously published induction protocols can greatly improve the accessibility of buprenorphine for patients and healthcare staff.

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