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48-hour Induction of Transdermal Buprenorphine to Extended-release Buprenorphine
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, MJI); Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (PA, NM); Addictions and Concurrent Disorders Research Group, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (JSHW, RMK); BC Mental Health & Substance Use Services, Provincial Health Services Authority, British Columbia, Canada (NM); Substance Use Response and Facilitation Service, BC Children's Hospital, Provincial Health Services Authority, British Columbia, Canada (MJI); Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada (NP); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (NP); British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada (AA, MH, RB, JSGM); Pharmacokinetics Modeling and Simulation Laboratory, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (ST, ARM); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (MH); School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (RB); and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (JSGM).
Abstract:
Buprenorphine extended-release (BUP-XR) provides sustained delivery of buprenorphine to control withdrawal and craving symptoms in the form of a monthly injectable and has been shown to improve health outcomes in patients with opioid use disorder. It is recommended that patients are stabilized with a transmucosal buprenorphine product, for at least 7 days per the product monograph; however, clinically, this timeline may be expedited. We report a case of a hospitalized patient with unregulated fentanyl use who underwent a successful transdermal buprenorphine induction for 48 hours to initiate BUP-XR with minimal levels of withdrawal and without precipitating opioid withdrawal. The approach described could provide a practical, patient-centered, accelerated induction strategy that, once independently validated, could considerably facilitate the use of BUP-XR.
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