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Buprenorphine/naloxone micro-induction in a tertiary care hospital: a retrospective cohort analysis

Robert Nunn1, Anne Sylvestre1, Kelly Sequeira1

  • 1St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.

Journal of Addictive Diseases
|July 2, 2023
PubMed
Abstract

Insights

Buprenorphine/naloxone micro-inductions successfully initiated 73% of hospitalized patients with opioid use disorder without prior abstinence. Variable dosing regimens were observed, indicating further research is needed for optimal treatment protocols.

Area of Science:

  • Addiction Medicine
  • Pharmacology

Background:

  • Opioid use disorder (OUD) is a significant public health crisis.
  • Hospitalized patients with OUD often face challenges in initiating medication for addiction treatment (MAT).
  • Buprenorphine/naloxone is a key medication for OUD treatment, but induction can be complex.

Purpose of the Study:

  • To describe the utilization and success rates of buprenorphine/naloxone micro-inductions in an inpatient setting.
  • To characterize prescribing patterns and patient outcomes associated with micro-induction protocols.

Main Methods:

  • Retrospective chart review of 33 hospitalized patients receiving buprenorphine/naloxone micro-inductions for OUD.
  • Analysis of prescribing patterns, patient demographics, withdrawal symptom frequency, and treatment success.
  • Success defined as retention on therapy without precipitated withdrawal.

Main Results:

  • Three primary micro-induction regimens were identified: rapid, 0.5 mg SL BID, and 0.5 mg SL daily.
  • 73% of patients (24/33) achieved successful micro-induction.
  • The main reason for failure was patient-initiated discontinuation due to adverse effects or preference.

Conclusions:

  • Buprenorphine/naloxone micro-induction is an effective strategy for initiating MAT in hospitalized patients, often without requiring prior opioid abstinence.
  • Observed variability in micro-induction dosing regimens suggests a need for further investigation into optimal protocols.
  • This approach facilitates timely OUD treatment initiation during hospitalization.
Keywords:
Bernese methodOpioid agonist therapybuprenorphinemicro-dosingmicro-induction

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