A Review of Novel Methods To Support The Transition From Methadone and Other Full Agonist Opioids To Buprenorphine/Naloxone Sublingual In Both Community and Acute Care Settings

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

“…The use of alternative induction protocols, such as rapid micro-induction, have consequently been utilized to address the concerns with the standard induction process. 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.…”

“…The rationale of this rapid dosing is based on the hypothesis that buprenorphine reaches peak plasma concentration in approximately an hour [ 22 ]. Rapid micro-induction offers several advantages over a standard induction method—eliminating the abstinence period preceding induction, reducing the risk of precipitated withdrawal, minimizing the symptoms of withdrawal and craving, potentially improving treatment retention, and reducing the time spent in hospital [ 17 , 19 ].…”

Intravenous Buprenorphine Micro-dosing Induction in a Patient on Methadone Treatment: A Case Report

“…Though very rapid buprenorphine induction (8h) of a patient on 50mg of methadone daily has been reported 19 , we chose a conservative 4-day induction schedule similar to previously reported SL protocols 8 .…”