Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series

Area of Science:

• Pharmacology
• Addiction Medicine
• Clinical Case Studies

Background:

• Discontinuing sublingual buprenorphine (SL-BUP) is a goal for some patients in opioid use disorder (OUD) treatment.
• Tapering SL-BUP can be challenging due to opioid withdrawal symptoms, increasing relapse risk.
• Extended-release subcutaneous buprenorphine (ER-BUP) is a potential alternative for managing withdrawal during tapering.

Purpose of the Study:

• To evaluate the use of a single 100 mg ER-BUP injection in patients experiencing withdrawal during SL-BUP taper.
• To describe patient characteristics, adverse effects, and outcomes associated with ER-BUP use for tapering.

Main Methods:

• Retrospective review of 8 patients undergoing SL-BUP taper who received a single 100 mg ER-BUP injection.
• Patients were on 2-6 mg SL-BUP daily prior to injection.
• Monitoring for adverse effects, withdrawal symptoms, and illicit opioid use for 12 months post-injection.

Main Results:

• Three patients reported mild adverse effects post-injection, primarily those on lower SL-BUP doses (2-3 mg).
• Over 12 months, 3 patients experienced mild, tolerable withdrawal symptoms.
• Two patients resumed SL-BUP; no patients returned to illicit opioid use.
• Buprenorphine elimination was observed around 24 weeks post-injection.

Conclusions:

• ER-BUP tapering appears better tolerated than traditional SL-BUP tapering, supporting existing evidence.
• A pre-injection SL-BUP dose of 2-6 mg may minimize severe adverse effects and withdrawal.
• Shared decision-making and established remission are crucial before initiating SL-BUP taper.