Rapid Induction of Buprenorphine/Naloxone for Chronic Pain Using a Microdosing Regimen: A Case Report

Abstract

Buprenorphine is an effective treatment for chronic pain and may reduce opioid-induced hyperalgesia. However, its pharmacological properties make its induction challenging, timeconsuming, and can precipitate opioid withdrawal. We present the case of a 66-year-old woman with inadequately controlled postoperative pain despite escalating doses of oxycodone and methadone, who was successfully transitioned to buprenorphine/naloxone using a rapid microinduction technique without precipitating opioid withdrawal. Rapid induction provides an alternative method for transitioning patients from other opioids to buprenorphine/naloxone and facilitates transition of patients with chronic pain to buprenorphine therapy within a shorter window compared to currently existing protocols.

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 [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].…”

Ambulatory microdose induction of buprenorphine‐naloxone in two adolescent patients with sickle cell disease

“…3 Case reports describe alternative approaches utilizing small, frequent doses of buprenorphine-naloxone to avoid withdrawal symptoms, and rapidly transition patients off full agonist opioids. [4][5][6][7][8][9][10][11][12][13] None of these case studies include adolescents or individuals with SCD.…”

“…Historically, induction of buprenorphine in opioid‐dependent individuals required mild to moderate opioid withdrawal and cessation of full opioid agonists for 24‐48 h in a clinical setting 3 . Case reports describe alternative approaches utilizing small, frequent doses of buprenorphine‐naloxone to avoid withdrawal symptoms, and rapidly transition patients off full agonist opioids 4–13 . None of these case studies include adolescents or individuals with SCD.…”

Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future

“…9,10 Recently, rapid induction of microdosing by the sublingual route has become more common. 11,12 The advantage of the rapid induction microdosing is that it takes 3 to 5 days, in comparison to the Bernese method, which usually takes more than 10 days. The microdosing regimens explained in the above literature tend to occur in classic inpatient settings.…”