Successful rotation from long-acting full agonist opioids to sublingual buprenorphine/naloxone using a microdosing approach

Authors

DOI:

https://doi.org/10.5055/jom.2021.0653

Keywords:

microdosing, buprenorphine/naloxone, buprenorphine, opioid use disorder, opioid substitution therapy

Abstract

Buprenorphine/naloxone (BPN/NX) is a first-line treatment for opioid use disorder. Conventional treatment guidelines recommend a period of opioid abstinence and the presence of moderate withdrawal before initiation to avoid precipitated withdrawal. A newer approach of “microdosing” removes this requirement and has potential benefits. We present two cases of successful induction of BPN/NX using a microdosing regimen in an inpatient withdrawal unit. Both cases did not result in precipitated withdrawal and did not necessitate prior cessation of other opioids. This case report highlights how the use of microdosing to induct BPN/NX treatment can reduce potential barriers and complications with treatment initiation.

Author Biographies

René C. Vytialingam, MBBS, FRACGP, FAChAM

Consultant in Addiction Medicine, Next Step Drug and Alcohol Services, Mental Health Commission, Western Australia, Perth, Australia

Stephan A. Schug, MD, FANZCA, FFPMANZCA, EDPM

Emeritus Professor and Honorary Senior Research Fellow, Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, Australia

Richard O’Regan, MBBS, FAChAM

Director of Clinical Services, Next Step Drug and Alcohol Services, Mental Health Commission, Western Australia, Perth, Australia

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Published

08/01/2021

How to Cite

Vytialingam, MBBS, FRACGP, FAChAM, R. C., S. A. Schug, MD, FANZCA, FFPMANZCA, EDPM, and R. O’Regan, MBBS, FAChAM. “Successful Rotation from Long-Acting Full Agonist Opioids to Sublingual buprenorphine/Naloxone Using a Microdosing Approach”. Journal of Opioid Management, vol. 17, no. 7, Aug. 2021, pp. 159-66, doi:10.5055/jom.2021.0653.