Street Pharmacology: The Mechanistic Basis of Clinical Pharmacology Underlying the Microdosing Method of Buprenorphine–Naloxone With a Focus on the Unhoused Population
David F. Lehmann, Olivia Tanner, Eliesha Pepple, Zarina Rashid Smith, Mia Ruiz‐Salvador
The Journal of Clinical Pharmacology June 1, 2026 DOI: 10.1002/jcph.70213 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Duration | Initial week of treatment |
| Topics | Microdosing |
| Keywords | Clinical pharmacology Abstinence Population Clinical trial Focus optics Pharmacodynamics Drug development Opioid |
| Key findings | Microdosing buprenorphine-naloxone does not require opioid abstinence or precipitate withdrawal, based on the pharmacodynamic principle of pseudo-irreversibility for a partial agonist. |
Abstract
Expanded use of buprenorphine-naloxone use, particularly for marginalized communities, such as the unhoused, is an established priority. Unfortunately, due to fear of the precipitation of opioid withdrawal, this goal remains unmet. In response, microdosing methods during the initial week of treatment do not require opioid abstinence and do not precipitate withdrawal. This review establishes the scientific basis for microdosing that is centered on the pharmacodynamic principle of pseudo-irreversibility for a partial agonist, such as buprenorphine.
Comparable studies
Other narrative reviews on microdosing, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Big physics, small doses: the use of AMS and PET in human microdosing of development drugs | 2003 | Review | |
| Phase 0/microdosing approaches: time for mainstream application in drug development? | 2020 | Review | |
| Microdosing and drug development: past, present and future | 2013 | Review | |
| Microdosing and Other Phase 0 Clinical Trials: Facilitating Translation in Drug Development | 2016 | Review | |
| Expectancy Effects in Psychedelic Trials. | 2024 | Review |