Management of treatment-refractory opioid use disorder: a case-series of a modified maintenance protocol

Reaching the maintenance phase and reducing illicit substance use in those with severe opioid use disorder (OUD) remains a large clinical challenge. The use of intravenous opioid agonist treatment has become a last-line treatment for severe OUD. In this case series, we describe a novel form of this treatment using both long-acting buprenorphine and injectable hydromorphone.

Retrospective chart review of cases in specialized enhanced addiction treatment centers in Alberta, Canada of patients prescribed long-acting injectable buprenorphine and intravenous hydromorphone.

We describe four cases of males ranging from 39 to 64 years of age with treatment-refractory opioid use disorder and multiple concurrent mental health and social issues who have experienced various periods of stability on long-acting injectable buprenorphine and along with intravenous hydromorphone or slow release oral morphine).

This case series presents a novel treatment combining buprenorphine extended-release injection with hydromorphone or slow release oral morphine for individuals with OUD who have not responded to standard opioid agonist treatment. The approach showed promise in managing withdrawal and cravings, potentially improving treatment retention. Further research is needed to evaluate long-term outcomes and optimize retention strategies to reduce opioid-related mortality.