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.
Comparable studies
Other case reports and case series on microdosing, most cited first.
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|---|---|---|---|
| Microdosing psilocybin for chronic pain: a case series Individuals with chronic neuropathic pain | 2022 | Case series | n = 3 |
| Microdosing of Psychoactive Substances in Business Practice Business managers and creative professionals | 2021 | Case study | |
| Treatment of neuropathic pain with repeated low-dose MDMA: a case report. 64-year-old male with neuropathic pain after chemotherapy and traumatic life experiences | 2025 | Case study | n = 1 |
| Psycholytic dosing or 'microdosing' of Amanita muscaria (red fly agaric) mushrooms—A retrospective case study A woman in her early thirties with depression, anxiety, and sleep disorders from... | 2023 | Case study | n = 1 |
| Clinical improvement following an integrative iboga microdosing protocol in post-concussive and hypoxic brain injury syndromes: a case series Three individuals with persistent neurologic symptoms after traumatic brain injury or... | 2026 | Case series | n = 3 |