A Case Report: Rapid Micro‐Induction of Buprenorphine/Naloxone to Administer Buprenorphine Extended‐Release in an Adolescent With Severe Opioid Use Disorder

Abstract

Background and Objectives Buprenorphine extended‐release (BUP‐XR) is a monthly injectable form of opioid agonist therapy. Before its administration, a minimum 7‐day induction period with a transmucosal buprenorphine‐containing product is recommended. Methods Case report (n = 1). Results A 16‐year‐old female with active, severe opioid use disorder (OUD) and stimulant use disorder, hepatitis C virus, co‐occurring mental health disorders, and complex social stressors had five recent overdoses requiring naloxone. She had previously been treated with methadone and several trials of sublingual buprenorphine/naloxone, but would quickly discontinue the treatment. Using a rapid micro‐induction protocol, buprenorphine/naloxone was administered for 3 days. On day 4, 300 mg BUP‐XR was administered subcutaneously. Minimal withdrawal symptoms occurred, despite recent fentanyl use. Discussion and Conclusions A rapid sublingual buprenorphine/naloxone micro‐induction was successfully used to initiate BUP‐XR, thereby eliminating the abstinence period prior to buprenorphine/naloxone administration, shortening the induction period, and minimizing withdrawal. Scientific Significance This is the first reported case of using rapid micro‐induction as a bridge to initiate BUP‐XR. By reducing the length of induction to 4 days and minimizing withdrawal, this induction method can make BUP‐XR more accessible to patients who would otherwise refuse the medication due to concerns of enduring withdrawal. (Am J Addict 2020;29:531–535)

Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: protocol for an open-label, parallel-group, superiority, randomized controlled trial

“…Buprenorphine/naloxone rapid micro-induction confers many benefits over a standard induction method, as it can minimize withdrawal and craving symptoms, reduce the risk of precipitated withdrawal, and length of induction [17,19]. Anecdotally and according to recent case reports and a review, clinicians have had much success with rapid-micro-induction, and the method has entered routine practice at some hospitals and clinics across Canada, the United States, and Europe [13][14][15][16][17][18][19][20][21].…”

“…To overcome the difficulties of a standard induction method of buprenorphine, a novel induction method, known as micro-induction (also called micro-dosing), is being explored and increasingly employed by many clinicians in Canada, the United States, and other parts of the world [13][14][15][16][17][18][19][20][21]. This induction method was first described as the Bernese method in a Swiss case series in 2016 [14].…”

“…Rapid micro-induction and variations of this novel induction method have been extensively described in several case reports and in a recent review, however, they have never been systematically evaluated in a clinical trial [13][14][15][16][17][18][19][20][21]. To generate the evidence for this induction method in the midst of the ongoing opioid crisis, the first randomized controlled trial was developed to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone.…”

Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: Protocol for an open-label, parallel-group, superiority, randomized controlled trial

“…To overcome the difficulties of a standard induction method of buprenorphine, a novel induction method, known as micro-induction (also called micro-dosing), is being explored and increasingly employed by many clinicians in Canada, the United States, and other parts of the world 12-20 . This induction method was first described as the ‘Bernese Method’ in a Swiss case series in 2016 13 .…”

“…Rapid micro-induction and variations of this novel induction method have been extensively described in several case reports and in a recent review, however, they have never been systematically evaluated in a clinical trial 12-20 . To generate the evidence for this induction method in the midst of the ongoing opioid crisis, we propose the first randomized controlled trial was developed to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone.…”