Microdosing Transdermal Buprenorphine to Transition a Patient off a Higher-Dose Methadone Regimen
Hannan Moses Braun, Kristy L. Blackwood, Jeffrey P. Bratberg, Seth A. Clark
preprint DOI: 10.21203/rs.3.rs-1156533/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report |
|---|---|
| Sample size | 1 |
| Population | Patient taking high-dose methadone |
| Intervention | as needed full opioid agonist |
| Topics | Microdosing |
| Key findings | A patient on high-dose methadone transitioned to buprenorphine via a transdermal microdosing protocol without prior methadone tapering and without opioid withdrawal symptoms. |
Abstract
Abstract Background Buprenorphine is a partial µ-opioid agonist with high receptor binding affinity and long half-life—qualities that reduce overdose risk with concomitant opioid use, though may precipitate withdrawal by displacing full agonists. Traditional buprenorphine induction typically requires patients endure moderate withdrawal prior to initiation, with challenges intensifying for patients transitioning from higher-dose methadone. Novel microinduction reports aim to remove this prerequisite, though with significant limitations.
Methods: Case report (n=1).
Results: Our patient taking high-dose methadone transitioned to buprenorphine using a transdermal microdosing protocol with an as needed full opioid agonist that did not require methadone dose tapering prior to initiation and avoided symptoms of opioid withdrawal.
Conclusions: Further research is needed to define optimal microdosing protocols, especially for patients on methadone and/or using illicit fentanyl.