Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach
Jennifer Rozylo, Keren Mitchell, Mohammadali Nikoo, S. Elise Durante, Skye P. Barbic, Daniel Lin, Steve Mathias, Pouya Azar
Addiction Science & Clinical Practice January 19, 2020 DOI: 10.1186/s13722-020-0177-x via DOAJ
Summary
AI-generated from the abstractA high-risk patient with opioid use disorder who had previously failed buprenorphine/naloxone induction due to withdrawal symptoms was successfully started on a therapeutic dose using a microdosing regimen combined with assertive outreach. The team gradually increased the dose without causing withdrawal, and the patient continued consistent medication use for four weeks, gradually reducing illicit substance use. The case suggests that microdosing can minimize barriers to buprenorphine/naloxone induction and supports the need for larger studies.
Study at a glance
| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | High-risk patient with opioid use disorder and history of failed buprenorphine/naloxone inductions |
| Intervention | Buprenorphine/naloxone microdosing |
| Duration | 4 weeks including induction period |
| Topics | Addiction Microdosing |
| Keywords | Buprenorphine/naloxone Bernese method Induction method |
| Key finding | A microdosing schedule enabled successful buprenorphine/naloxone induction without apparent withdrawal in a patient who had previously failed induction. |
Abstract
Abstract Background The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction. Case presentation We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual’s opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks. Conclusions A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.