Microinduction of Buprenorphine/Naloxone: A Review of the Literature.

  title={Microinduction of Buprenorphine/Naloxone: A Review of the Literature.},
  author={Saeed Ahmed and Siddhi Bhivandkar and Brady B. Lonergan and Joji Suzuki},
  journal={The American journal on addictions},
BACKGROUND AND OBJECTIVES Buprenorphine's high-binding affinity as a partial µ-opioid agonist displaces preexisting full agonists causing precipitated withdrawal, which requires most individuals starting buprenorphine to endure moderate withdrawal prior to induction to avoid precipitated withdrawal. A novel approach called microinduction has emerged to remove this prerequisite. Our aim is to review the literature on these alternative approaches. METHODS Using keywords including buprenorphine… 
Blister-Packing of 2 mg Buprenorphine Monoproduct as a Patient-Centered Method of Microdosing for Buprenorphine Induction
This work worked with the smallest available dose of buprenorphine monoproduct, the 2 mg tablet, and developed this blister pack regimen using a 7×4 standard weekly packaging system, based on the microdosing regimen described by Randhawa et al.
Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review
This review aims to systematically review the buprenorphine initiation strategies that have emerged in the last decade and suggests that concomitant administration of small doses of bupenorphine with opioids can avoid the unwanted withdrawal associated with bupreliminary initiation.
Transdermal buprenorphine for in-hospital transition from full agonist opioids to sublingual buprenorphine: a retrospective observational cohort study
The use of transdermal buprenorphine to facilitate induction of sublingual bupenorphine therapy in hospitalized patients with OUD was generally well-tolerated in this single-center retrospective observational study.
Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting – a case series
Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible and safe via 4 mg bupenorphine sublingual, and this procedure may facilitate induction of bup Renorphine depot formulations in patients treated with methadon.
Low-dose Buprenorphine Initiation in Hospitalized Adults With Opioid Use Disorder: A Retrospective Cohort Analysis
Low-dose buprenorphine initiation offers a well-tolerated and versatile approach for hospitalized patients with OUD and is applied to recommendations for varied clinical scenarios, including acute illness, co-occurring pain, opioid withdrawal intolerance, transition from high dose methadone to bupenorphine, history of precipitated withdrawal, and rapid hospital discharge.
Transition From Full Mu Opioid Agonists to Buprenorphine in Opioid Dependent Patients—A Critical Review
  • M. Soyka
  • Psychology, Biology
    Frontiers in Pharmacology
  • 2021
A number of dosing strategies have been proposed to soften withdrawal symptoms and facilitate transfer including use of other opioids or medications and especially microdosing techniques for buprenorphine.
Treating opioid use disorder with rapid micro induction technique of sublingual buprenorphine/naloxone in an outpatient setting—a case report
This case report shows a modified, expedited approach of transition from methadone to buprenorphine after a patient cannot tolerate full abstinence from opioids during traditional induction.
Treating Opioid Withdrawal in the Hospital: A Role for Short-Acting Opioids
Short-acting opioids may complement the use of methadone and buprenorphine for OWS in the hospital, addressing pharmacodynamic limitations of these medications and enabling more patient-centered models of OWS treatment, supporting the autonomy and subjective experience of hospitalized patients who use drugs.
Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail
The human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination are discussed.


Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach
A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use.
Rapid Induction Therapy for Opioid-Use Disorder Using Buprenorphine Transdermal Patch: A Case Series.
It is believed that this approach can be used in a wide range of patients to transition from opioid use to buprenorphine therapy without the patient having to experience withdrawal or wait to start treatment.
Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.
Buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate dosages.
Suboxone: Rationale, Science, Misconceptions.
This epidemic is attributable to a confluence of circumstances, primarily overprescribing by physicians combined with an influx of potent heroin from Mexico, and the rise of extremely potent synthetic opioids such as fentanyl, carfentanil, and others.
Buprenorphine Induction Without Opioid Withdrawal: A Case Series of 15 Opioid-Dependent Inpatients Induced on Buprenorphine Using Microdoses of Transdermal Buprenorphine.
Conventional guidelines recommended abstaining from other opioids, waiting long enough to enter mild– moderate opioid withdrawal before starting buprenorphine, but this is not feasible for many patients with severe pain requiring opioids.
Buprenorphine–naloxone “microdosing”: an alternative induction approach for the treatment of opioid use disorder in the wake of North America’s increasingly potent illicit drug market
It is agreed that appropriate therapy should be used to manage opioid use disorders, with buprenorphine–naloxone being a first-line option, and a substantial limitation of this medication, however, is the need for patients to abstain from opioids.
Case Report: “Striving to Skip the Withdrawal” Using Buprenorphine–Naloxone Microdosing for Hospitalized Patients
ABSTRACTOpioid substitution therapy is a life-saving, first-line treatment for patients with opioid use disorder. It is a key intervention to prevent further mortality and morbidity during the opioid