Buprenorphine/naloxone micro-induction in a tertiary care hospital: a retrospective cohort analysis

Nunn, Robert; Sylvestre, Anne M.; Sequeira, Kelly; Tanzini, Rosa Maria

doi:10.1080/10550887.2023.2229609

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…While vast, evidence surrounding LDBI is limited to case series, [8][9][10][11][12] feasibility studies, 13 single-arm retrospective cohort studies, [14][15][16] and comparative studies using historical controls. 17 There are no prospective, randomized studies directly comparing clinical outcomes of varying buprenorphine dosing strategies.…”

Section: Current Evidencementioning

confidence: 99%

Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician

Zimmerman,

Clark,

Guerra

et al. 2023

Substance Abuse

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Low dose buprenorphine initiation (LDBI) is a dosing strategy used to transition patients from full opioid agonists to buprenorphine. The purpose of LDBI is to circumvent obstacles associated with disruption in analgesia, precipitated withdrawal, and prerequisite opioid withdrawal prior to initiating buprenorphine, as not all patients are able to tolerate physical withdrawal symptoms recommended by national guidelines. No literature exists directly comparing traditional buprenorphine initiation to LDBI. Until information on long-term outcomes is available, these dosing strategies should be reserved for patients unable to tolerate traditional buprenorphine initiation. Available published research suggests LDBI strategies will allow some patients to successfully transition to buprenorphine with minimal or no symptoms of withdrawal. Ensuring access to pharmacotherapy during hospital admission is a crucial time for potential intervention and should be considered when appropriate. This narrative review discusses the background of LDBI strategies as well as practical clinical and operational considerations for the inpatient clinician.

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Section: Current Evidencementioning

confidence: 99%

Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician

Zimmerman,

Clark,

Guerra

et al. 2023

Substance Abuse

View full text Add to dashboard Cite

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Case report: Successful induction of buprenorphine in medically complex patients concurrently on opioids: a case series at a tertiary care center

Shelton,

Nama,

Hall

et al. 2024

Front. Pharmacol.

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Effective pain management is essential for optimal surgical outcomes; however, it can be challenging in patients with a history of opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a valuable treatment option for patients with OUD. Initiating buprenorphine treatment in patients concurrently taking opioids can be complex due to potential adverse outcomes like precipitated withdrawal. Evolving guidelines suggest there are benefits to continuing buprenorphine for surgical patients throughout the perioperative period, however situations do arise when buprenorphine has been discontinued. Typically, in this scenario patients would be restarted on buprenorphine after they have fully recovered from post-surgical pain and no longer require opioids for pain control. Unfortunately, holding MOUD may expose the patient to risks such as opioid induced respiratory depression or addiction relapse. In this case series, we discuss a novel method to restart buprenorphine in small incremental doses, known as micro-dosing, while the patient is still taking opioids for pain. We will present two complex clinical cases when this method was used successfully at a tertiary care hospital system.

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Buprenorphine/naloxone micro-induction in a tertiary care hospital: a retrospective cohort analysis

Cited by 2 publications

References 13 publications

Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician

Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician

Case report: Successful induction of buprenorphine in medically complex patients concurrently on opioids: a case series at a tertiary care center

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