Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine–Naloxone Through Microdosing: A Case Report
Isaiah T. Crum, VaKara M. Meyer Karre, Alëna A. Balasanova
A&A Practice September 21, 2020 DOI: 10.1213/xaa.0000000000001316 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Patient with chronic noncancer pain and intrathecal hydromorphone–bupivacaine pump |
| Intervention | Buprenorphine–naloxone |
| Topics | Microdosing |
| Key findings | Microdosing sublingual buprenorphine–naloxone successfully weaned a patient off intrathecal hydromorphone without opioid withdrawal or ventilatory depression. |
Abstract
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone–bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine–naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.
Comparable studies
Other case reports and case series on microdosing, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 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 |