Low-dose buprenorphine initiation during pregnancy: a case report

Buprenorphine is recommended for pregnant patients with opioid use disorder. Traditional buprenorphine initiation requires moderate withdrawal symptoms to prevent precipitating withdrawal. Low-dose buprenorphine initiation is newly emerging and does not require withdrawal prior to initiation. Case 1 is a 30-year-old pregnant patient with opioid use disorder. Inpatient rapid buprenorphine initiation precipitated withdrawal. Low-dose buprenorphine initiation was started twice, 1 outpatient and 1 inpatient with nonprescribed opioid use between. Case 2 is a 28-year-old pregnant patient with opioid use disorder. The patient started an inpatient low-dose buprenorphine initiation and planned its completion at home after discharge. Neither patient experienced precipitated withdrawal during their low-dose initiations. These buprenorphine initiations in pregnant patients guided by a low-dose initiations protocol using only split buprenorphine-naloxone films represent an alternative opioid use disorder treatment method with potentially high acceptability. Future work is warranted to advance the evidence base informing clinicians on how to optimally individualize buprenorphine initiations in pregnancy.