Buprenorphine Microdosing for the Pain and Palliative Care Clinician
Kyle Quirk, Maximillian H. Stevenson
Journal of Palliative Medicine December 20, 2021 DOI: 10.1089/jpm.2021.0378 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Population | Patients using opioids for pain |
| Topics | End-of-life distress Microdosing |
| Key findings | Microdosing induction of buprenorphine is a viable alternative to traditional inductions for patients on higher doses of opioids, with the most common strategy involving divided doses of sublingual products. |
Abstract
Buprenorphine (BUP) can be a safe and effective alternative to traditional opioids for many patients with chronic pain. For patients on higher doses of opioids, rotation to BUP is complicated by the requirement of an opioid-free interval or withdrawal during the transition. Microdosing inductions, in which BUP is gradually titrated, while full agonist opioids are continued, are a viable alternative to traditional inductions. The objective of this article is to review the current literature on BUP microdosing induction, with a focus on patients using opioids for pain. A literature review of the PubMed database was performed in the United States on articles published from inception to May 2021. A total of 34 publications were included. The most commonly utilized microdosing strategy involved administering divided doses of sublingual (SL) products marketed for opioid use disorder treatment, with 25 (73.5%) articles reporting use of partial SL tablets or films (ranging from 1/8 to 1/2 of a 2 mg product) at some point during the induction. Transdermal patches, low-dose SL BUP available in Europe, intravenous BUP, and buccal BUP have also been used. Beyond the products used, the speed of the microinduction, setting, final BUP dosing, and management of concomitant full agonists vary widely in the literature. Microdosing regimens should be individualized based on local guidelines and patient-specific factors. Further studies comparing the safety and efficacy of different protocols are warranted.
Comparable studies
Other narrative reviews on end-of-life distress, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness. Palliative care clinicians and patients | 2022 | Review | |
| The Potential of Psychedelics for End of Life and Palliative Care. Patients with life-threatening diagnoses | 2022 | Review | |
| Psilocybin in Palliative Care: An Update. Palliative care patients | 2023 | Review | |
| Psychedelic medicines for end-of-life care: Pipeline clinical trial review 2022. People with terminal illnesses experiencing depression, anxiety, or existential distress | 2023 | Scoping review | n = 25 |
| Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application—a review | 2024 | Narrative review |
Citations in the library
Cited by 3
- Buprenorphine 'microdosing' method for switching patients with opioid dependence from methadone to buprenorphine. BMJ Case Reports November 7, 2024
- Inpatient Transition from Methadone to Buprenorphine–Naloxone Using a Microdosing Strategy in a Postoperative Cancer Patient: A Case Report Journal of Palliative Medicine April 30, 2024
- Buprenorphine Microdosing Cross Tapers: A Time for Change International Journal of Environmental Research and Public Health December 8, 2022
Cites 5
- Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study Frontiers in Pharmacology March 23, 2021
- Microdosing and standard‐dosing take‐home buprenorphine from the emergency department: A feasibility study Journal of the American College of Emergency Physicians Open October 20, 2020
- Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine–Naloxone Through Microdosing: A Case Report A&A Practice September 21, 2020
- Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach Addiction Science & Clinical Practice January 19, 2020
- Rapid Induction of Buprenorphine/Naloxone for Chronic Pain Using a Microdosing Regimen: A Case Report A&A Practice January 15, 2020