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Switch from methadone to buprenorphine with microinduction in outpatient setting
Farid Juya1, John Fredrik Askjer1, Linda Merete Kaaberg Dahl1
1Klinikk psykisk helse og avhengighet, Sykehuset i Vestfold, Tønsberg.
Background:
Switching from methadone to buprenorphine in patients receiving opioid maintenance therapy often requires inpatient care with a gradual tapering of methadone and an opioid-free day with challenging withdrawal symptoms. This case report describes and discusses a gentle outpatient approach without the opioid-free day.
Case Presentation:
A patient with a 15-year history of opioid maintenance therapy reduced his methadone dose from 80 mg to 50 mg due to concurrent use of other sedative substances and a significant risk of overdose. A week-long switch to buprenorphine 16 mg subcutaneous depot formulation was then undertaken using a microinduction approach in the outpatient setting.
Interpretation:
In line with earlier reports on microinduction, the switch from methadone to buprenorphine was carried out with no opioid withdrawal symptoms or complications. Microinduction offers a smooth and more patient-friendly approach to switching from full opioid agonists to partial agonists. Randomised controlled trials are, however, needed for a systematic evaluation of this method.
Insights
Switching from methadone to buprenorphine can be done gently in an outpatient setting. This microinduction approach avoids opioid withdrawal symptoms, offering a patient-friendly alternative for opioid maintenance therapy.
Area of Science:
- Addiction Medicine
- Pharmacology
Background:
- Opioid maintenance therapy (OMT) often involves methadone.
- Switching from methadone to buprenorphine can be challenging, typically requiring inpatient care and causing withdrawal.
- Current methods often necessitate an opioid-free day, leading to discomfort.
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