Jessica Moe1, Fiona O'Sullivan2, Corinne M Hohl3, Mary M Doyle-Waters4, Claire Ronsley5, Raymond Cho6, Qixin Liu7, Pouya Azar8. 1. Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z IM9, Canada; Department of Emergency Medicine, Vancouver General Hospital, 920 West 10(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada; BC Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia V5Z 4R4, Canada. Electronic address: jessica.moe@ubc.ca. 2. Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z IM9, Canada. Electronic address: fiona.osullivan@ubc.ca. 3. Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z IM9, Canada; Department of Emergency Medicine, Vancouver General Hospital, 920 West 10(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, 828 West 10(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: chohl@mail.ubc.ca. 4. Centre for Clinical Epidemiology and Evaluation, 828 West 10(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: mimi.doyle-waters@ubc.ca. 5. Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada. Electronic address: claireronsley@gmail.com. 6. Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada. Electronic address: raymond.cho@alumni.ubc.ca. 7. University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z3, Canada. Electronic address: cindy_liu17@hotmail.com. 8. Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, British Columbia V6T 2A1, Canada; Complex Pain and Addictions Services, Vancouver General Hospital, 899 West 12(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: pouya1844@gmail.com.
Abstract
BACKGROUND/ OBJECTIVES: Micro-induction is a novel buprenorphine induction approach that seeks to avoid withdrawal and minimize precipitated withdrawal, both barriers to standard inductions. We aimed to synthesize evidence on micro-induction effectiveness, and regimens described. METHODS: We searched scientific databases and grey literature for studies including adolescents or adults with opioid use disorder who received buprenorphine micro-induction. Study selection, data extraction and quality assessments occurred in duplicate. We narratively synthesized results. RESULTS: We screened 4,752 citations and included 19 case studies/series and one feasibility study (n = 57 patients; mean age 38 years [SD 12.0]; 57.9% male [33/57]). Studies described 26 regimens; starting and maintenance doses ranged from 0.03 to 1.0 mg, and 8 to 32 mg, respectively. We calculated rate of increase to 8 mg. All patients achieved the desired maintenance dose. Among 54 patients in whom precipitated withdrawal was not reported, mean increases were 1.36 mg/day (SD 0.41). For three patients in whom precipitated withdrawal was specifically reported, mean increase was 1.17 mg/day (SD 0.11). All studies were low quality. DISCUSSION: Described regimens are highly variable. Inconsistent reporting, selection bias, and poor quality evidence limit conclusions regarding optimal dosing, and patient characteristics and clinical settings in which micro-induction is likely beneficial. CONCLUSIONS: This systematic review provides the most up-to-date synthesis on buprenorphine micro-induction regimens. Rigorous studies evaluating effectiveness and safety of micro-induction, and patient and clinical factors influencing its success, are needed.
BACKGROUND/ OBJECTIVES: Micro-induction is a novel buprenorphine induction approach that seeks to avoid withdrawal and minimize precipitated withdrawal, both barriers to standard inductions. We aimed to synthesize evidence on micro-induction effectiveness, and regimens described. METHODS: We searched scientific databases and grey literature for studies including adolescents or adults with opioid use disorder who received buprenorphine micro-induction. Study selection, data extraction and quality assessments occurred in duplicate. We narratively synthesized results. RESULTS: We screened 4,752 citations and included 19 case studies/series and one feasibility study (n = 57 patients; mean age 38 years [SD 12.0]; 57.9% male [33/57]). Studies described 26 regimens; starting and maintenance doses ranged from 0.03 to 1.0 mg, and 8 to 32 mg, respectively. We calculated rate of increase to 8 mg. All patients achieved the desired maintenance dose. Among 54 patients in whom precipitated withdrawal was not reported, mean increases were 1.36 mg/day (SD 0.41). For three patients in whom precipitated withdrawal was specifically reported, mean increase was 1.17 mg/day (SD 0.11). All studies were low quality. DISCUSSION: Described regimens are highly variable. Inconsistent reporting, selection bias, and poor quality evidence limit conclusions regarding optimal dosing, and patient characteristics and clinical settings in which micro-induction is likely beneficial. CONCLUSIONS: This systematic review provides the most up-to-date synthesis on buprenorphine micro-induction regimens. Rigorous studies evaluating effectiveness and safety of micro-induction, and patient and clinical factors influencing its success, are needed.
Authors: Neil B Varshneya; Ashish P Thakrar; J Gregory Hobelmann; Kelly E Dunn; Andrew S Huhn Journal: J Addict Med Date: 2021-11-23 Impact factor: 4.647
Authors: August F Holtyn; Forrest Toegel; Matthew D Novak; Jeannie-Marie Leoutsakos; Michael Fingerhood; Kenneth Silverman Journal: Drug Alcohol Depend Date: 2021-05-27 Impact factor: 4.852