In our early clinical experience with the absorbable polymer matrix scaffold P4HB, it seemed to provide superior clinical performance and value-based benefit compared with porcine cadaveric biologic mesh.
The traditional method of transitioning from methadone to buprenorphine requires a gradual dose reduction to a low dose of 30 mg daily, followed by cessation, and addressing withdrawal symptoms prior to the initiation of buprenorphine. This process can be time-consuming and is also associated with tremendous patient suffering and adverse outcomes. In recent years, several protocols have emerged based on the notion of blunting the shift from full receptor activation to partial receptor activation via an intermediate "bridge". This typically is required for the time period needed for the acting full agonist, methadone, to undergo biotransformation and clearance. In this report, we present an inadvertent case where transdermal fentanyl as a transitional bridge was utilized along with an inducer of methadone's metabolism to speed up the course, and urine acidification to enhance clearance. Our patient was transitioned from moderate-dose methadone, without encountering any withdrawal symptoms in the process, in three days. This method presents yet another option for select candidates, and it allows physicians to individualize methadone-tobuprenorphine transitions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.