Buprenorphine Induction Using Microdosing for the Management of Opioid Use Disorder in Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Addiction Medicine
• Pharmacology

Background:

• Conventional buprenorphine induction necessitates opioid abstinence, often causing withdrawal.
• Pregnant individuals with opioid use disorder face challenges in treatment transitions.
• Minimizing neonatal opioid withdrawal syndrome (NOWS) is a key goal in prenatal care.

Observation:

• A pregnant patient at 18 2/7 weeks' gestation switched from methadone to buprenorphine via microdosing.
• The patient received increasing buprenorphine microdoses over 7 days while continuing methadone.
• She tolerated microdosing well, experiencing no withdrawal symptoms or cravings, and continued prenatal care.

Findings:

• Buprenorphine microdosing allowed a gradual switch from methadone without inducing maternal withdrawal.
• The patient delivered a healthy infant at 39 weeks' gestation with no need for NOWS interventions.
• Buprenorphine microdosing was well-tolerated and effective in this pregnant patient.

Implications:

• Buprenorphine microdosing may be a viable strategy to manage opioid use disorder in pregnancy.
• This method could potentially reduce the incidence and severity of neonatal opioid withdrawal syndrome.
• Further clinical studies on buprenorphine microdosing during pregnancy are warranted.