Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting – a case series

Abstract

Background: Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described. Objectives: To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated. Methods: Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours. Results: Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients. Conclusions: Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.

Transition From Full Mu Opioid Agonists to Buprenorphine in Opioid Dependent Patients—A Critical Review

“…The optimal tactics for direct transfer from methadone to long-lasting buprenorphine formulations has not been defined. A recent case series of Soyka and Groß (2021) of patients with opioid use disorder in a custodial setting suggests that a rapid transfer from methadone, in part at high dosages, to depot buprenorphine via an initial 4 mg sublingual buprenorphine dose is possible. Microdosing techniques to introduce a patient to depot buprenorphine medication has been recently advocated also by Tay Wee Teck et al (2021) .…”