Abstract
BackgroundThe requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction.Case presentationWe aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual’s opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks.ConclusionsA microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.
Highlights
The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction.Case presentation: We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms
A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use
This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach
Summary
The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction.Case presentation: We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Since 2015, illicit drug use has surpassed suicide as the major cause of unnatural deaths in BC, with fentanyl-related overdoses implicated as the leading cause of illicit drug overdoses [1] This public health crisis of historical scale has taken more lives than the HIV epidemic in the early 1990′s [2]. The latter at its peak (1995) was identified as the cause of a Opioid agonist treatment (OAT) has been shown to reduce morbidity and mortality among patients with opioid use disorder (OUD) [5,6,7,8,9,10]. Precipitated withdrawal can result if buprenorphine/naloxone is introduced in the presence of other opiates with lesser-binding affinities, such as heroin or methadone; patients are required to be in moderate withdrawal prior to induction
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