Pouya Azar1, James S H Wong2, Sara Jassemi3, Eva Moore3, Dzung X Vo3, Mohammadali Nikoo2, Samantha Young4,5. 1. Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 2. Addictions and Concurrent Disorders Research Group, Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada. 3. Department of Pediatrics, Division of Adolescent Health and Medicine, B.C. Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 4. British Columbia Centre on Substance Use, British Columbia Centre for Excellence, St. Paul's Hospital, Vancouver, British Columbia, Canada. 5. Department of Medicine, Interdepartmental Division of Addiction Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Buprenorphine extended-release (BUP-XR) is a monthly injectable form of opioid agonist therapy. Before its administration, a minimum 7-day induction period with a transmucosal buprenorphine-containing product is recommended. METHODS: Case report (n = 1). RESULTS: A 16-year-old female with active, severe opioid use disorder (OUD) and stimulant use disorder, hepatitis C virus, co-occurring mental health disorders, and complex social stressors had five recent overdoses requiring naloxone. She had previously been treated with methadone and several trials of sublingual buprenorphine/naloxone, but would quickly discontinue the treatment. Using a rapid micro-induction protocol, buprenorphine/naloxone was administered for 3 days. On day 4, 300 mg BUP-XR was administered subcutaneously. Minimal withdrawal symptoms occurred, despite recent fentanyl use. DISCUSSION AND CONCLUSIONS: A rapid sublingual buprenorphine/naloxone micro-induction was successfully used to initiate BUP-XR, thereby eliminating the abstinence period prior to buprenorphine/naloxone administration, shortening the induction period, and minimizing withdrawal. SCIENTIFIC SIGNIFICANCE: This is the first reported case of using rapid micro-induction as a bridge to initiate BUP-XR. By reducing the length of induction to 4 days and minimizing withdrawal, this induction method can make BUP-XR more accessible to patients who would otherwise refuse the medication due to concerns of enduring withdrawal. (Am J Addict 2020;29:531-535).
BACKGROUND AND OBJECTIVES:Buprenorphine extended-release (BUP-XR) is a monthly injectable form of opioid agonist therapy. Before its administration, a minimum 7-day induction period with a transmucosal buprenorphine-containing product is recommended. METHODS: Case report (n = 1). RESULTS: A 16-year-old female with active, severe opioid use disorder (OUD) and stimulant use disorder, hepatitis C virus, co-occurring mental health disorders, and complex social stressors had five recent overdoses requiring naloxone. She had previously been treated with methadone and several trials of sublingual buprenorphine/naloxone, but would quickly discontinue the treatment. Using a rapid micro-induction protocol, buprenorphine/naloxone was administered for 3 days. On day 4, 300 mg BUP-XR was administered subcutaneously. Minimal withdrawal symptoms occurred, despite recent fentanyl use. DISCUSSION AND CONCLUSIONS: A rapid sublingual buprenorphine/naloxone micro-induction was successfully used to initiate BUP-XR, thereby eliminating the abstinence period prior to buprenorphine/naloxone administration, shortening the induction period, and minimizing withdrawal. SCIENTIFIC SIGNIFICANCE: This is the first reported case of using rapid micro-induction as a bridge to initiate BUP-XR. By reducing the length of induction to 4 days and minimizing withdrawal, this induction method can make BUP-XR more accessible to patients who would otherwise refuse the medication due to concerns of enduring withdrawal. (Am J Addict 2020;29:531-535).
Authors: Nickie Mathew; Pouya Azar; James S H Wong; Mohammadali Nikoo; Jean N Westenberg; Janet G Suen; Jennifer Y C Wong; Reinhard M Krausz; Christian G Schütz; Marc Vogel; Jesse A Sidhu; Jessica Moe; Shane Arishenkoff; Donald Griesdale Journal: Addict Sci Clin Pract Date: 2021-02-12