Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician

Area of Science:

• Addiction Medicine
• Pharmacology
• Clinical Practice

Background:

• Traditional buprenorphine initiation can be challenging due to withdrawal symptoms.
• Some patients struggle to tolerate the prerequisite opioid withdrawal for standard buprenorphine initiation.
• Low dose buprenorphine initiation (LDBI) is a strategy to mitigate these challenges.

Purpose of the Study:

• To review the background and clinical considerations of LDBI.
• To discuss LDBI as an alternative for patients unable to tolerate traditional initiation.
• To highlight the potential of LDBI in managing opioid agonist transitions.

Main Methods:

• This is a narrative review.
• Literature on LDBI strategies was reviewed.
• Clinical and operational aspects for inpatient clinicians were discussed.

Main Results:

• No direct comparative literature exists between LDBI and traditional buprenorphine initiation.
• Published research suggests LDBI can facilitate a smoother transition with minimal withdrawal.
• LDBI may be a viable option for specific patient populations.

Conclusions:

• LDBI should be reserved for patients unable to tolerate traditional buprenorphine initiation until long-term outcomes are known.
• Inpatient settings are opportune for initiating pharmacotherapy like LDBI.
• LDBI shows promise in improving patient transitions to buprenorphine therapy.