Buprenorphine microinductions: Investigating the ideal initial dose based on oral morphine equivalent requirements...

To determine if a relationship exists between oral morphine equivalent (OME) requirements to stabilize acute opioid withdrawal symptoms and the initial buprenorphine dose in patients who successfully complete a buprenorphine microinduction, defined as discharge on buprenorphine.

Retrospective chart review.

Single-center community teaching hospital in Lancaster, Pennsylvania.

Included adult patients admitted to Penn Medicine Lancaster General Hospital from February 1, 2022, to February 1, 2025, with opioid use disorder, who attempted a buprenorphine microinduction. A microinduction was defined as an initial sublingual buprenorphine dose less than 2 mg or a buccal dose less than 900 mcg. Patients were excluded if they were on buprenorphine prior to admission. Thirty patients met criteria for inclusion.

To determine if the 24-hour OME received on the day of buprenorphine initiation (stabilizing OME) is predictive of the starting buprenorphine dose among patients who had a successful microinduction.

Of the 30 patients, 25 (83.3 percent) successfully completed a microinduction. Among these 25 patients, there was no statistically significant association found between the initial buprenorphine dose and either the stabilizing OME or the self-reported quantity of illicit opioid use. Similarly, microinduction length was not significantly associated with either variable.

Findings support an individualized approach to buprenorphine microinductions, as no statistically significant associations were found between the initial buprenorphine dose and stabilizing OME requirements.