AANA Journal Course--Optimizing Buprenorphine Induction: Updated Approaches in Opioid Use Disorder Management

Buprenorphine's unique pharmacologic profile and safety characteristics make it a first-line treatment for opioid use disorder (OUD). While buprenorphine is increasingly used in opioid dependence treatment, transitioning patients from full opioid agonists to buprenorphine remains a clinical challenge, particularly due to limited familiarity and complexities of induction of buprenorphine in managing OUD. Traditional clinical guidelines recommend initiating buprenorphine following a period of mild-to-moderate prerequisite opioid withdrawal. However, during the transition, inadequate equianalgesic dosing and inappropriate timing and routes of buprenorphine administration may precipitate withdrawal symptoms. Two primary induction strategies, microdosing and bridging, have currently demonstrated success in minimizing withdrawal and improving patient comfort. This journal course examines these two strategies when switching patients from common opioids to buprenorphine. Additionally, this article reviews the pharmacologic mechanisms of buprenorphine, compares the two induction techniques, and explores regulatory and practical considerations with current, evidence-based guidance on initiating buprenorphine in opioid-dependent patients for safer and more effective OUD care.