Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2020

01-12-2020 | Naloxone | Case Study

Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach

Authors: Jennifer Rozylo, Keren Mitchell, Mohammadali Nikoo, S. Elise Durante, Skye P. Barbic, Daniel Lin, Steve Mathias, Pouya Azar

Published in: Addiction Science & Clinical Practice | Issue 1/2020

Login to get access

Abstract

Background

The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction.

Case presentation

We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual’s opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks.

Conclusions

A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.
Literature
1.
British Columbia Coroners Service. Illicit drug overdose deaths in BC January 1, 2008–January 31, 2018; 2018.
2.
Global Commission on Drug Policy. The opioid crisis in North America; 2017.
3.
4.
Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: apparent opioid-related deaths in (released September 2018)—Canada.ca. Ottawa; 2018.
5.
6.
7.
Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane database Syst Rev. 2011;8:CD004145.
8.
Nolan S, Hayashi K, Milloy MJ, Kerr T, Dong H, Lima VD, et al. The impact of low-threshold methadone maintenance treatment on mortality in a Canadian setting. Drug Alcohol Depend. 2015;156:57–61.CrossRef
9.
Hser Y-I, Evans E, Huang D, Weiss R, Saxon A, Carroll KM, et al. Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial. Addiction. 2016;111(4):695–705.CrossRef
10.
Clausen T, Anchersen K, Waal H. Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1–3):151–7.CrossRef
11.
British Columbia Center on Substance Use. A guideline for the clinical management of opioid use disorder; 2017.
12.
Bruneau J, Ahamad K, Goyer MÈ, Poulin G, Selby P, Fischer B, et al. Management of opioid use disorders: a national clinical practice guideline. CMAJ. 2018;190:E247–57.CrossRef
13.
Daniulaityte R, Carlson R, Brigham G, Cameron D, Sheth A. Sub is a weird drug: a web-based study of lay attitudes about use of buprenorphine to self-treat opioid withdrawal symptoms. Am J Addict. 2015;24:403–9.CrossRef
14.
Teruya C, Schwartz RP, Mitchell SG, Hasson AL, Thomas C, Buoncristiani SH, et al. Patient perspectives on buprenorphine/naloxone: A qualitative study of retention during the starting treatment with agonist replacement therapies (START) study. J Psychoactive Drugs. 2014;46:412–26.CrossRef
15.
Srivastava A, Kahan M, Leece P, McAndrew A. Buprenorphine unobserved “home” induction: a survey of Ontario’s addiction physicians. Addict Sci Clin Pract. 2019;14:18.CrossRef
16.
Hämmig R. Einleitung einer Substitutionsbehandlung mit Buprenorphin unter vorübergehender Überlappung mit Heroinkonsum: ein neuer Ansatz (“Berner Methode”) [Induction of a buprenorphine substitution treatment with temporary overlap of heroin use: a new approach (“Bernese Method”)]. Suchttherapie. 2010;11:129–32 (in German).CrossRef
17.
Hammig R, Kemter A, Strasser J, von Bardeleben U, Gugger B, Walter M, et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. Subst Abuse Rehabil. 2016;7:99–105.CrossRef
18.
19.
20.
Bond GR, Drake RE. The critical ingredients of assertive community treatment. World Psychiatry. 2015;14:240–2.CrossRef
21.
22.
Jones AA, Jang K, Panenka WJ, Barr AM, MacEwan GW, Thornton AE, et al. Rapid change in fentanyl prevalence in a community-based high-risk sample. JAMA Psychiatry. 2018;75(3):298–300.CrossRef
23.
24.
Bell J, Trinh L, Butler B, Randall D, Rubin G. Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment. Addiction. 2009;104:1193–200.CrossRef
25.
Stein MD, Cloe P, Friedmann PD. Brief report: buprenorphine retention in primary care. J Gen Intern Med. 2005;20:1038–41.CrossRef
26.
Mattick RP, Ali R, White JM, O’Brien S, Wolk S, Danz C. Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction. 2003;98:441–52.CrossRef
Metadata
Title
Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach
Authors
Jennifer Rozylo
Keren Mitchell
Mohammadali Nikoo
S. Elise Durante
Skye P. Barbic
Daniel Lin
Steve Mathias
Pouya Azar
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2020
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-020-0177-x

Other articles of this Issue 1/2020

Addiction Science & Clinical Practice 1/2020 Go to the issue

Research

Chinese- and English-speaking adult current smokers’ perspectives on smoking and culturally and linguistically appropriate cessation: a qualitative analysis

Review

How do state Medicaid programs determine what substance use disorder treatment medications need prior authorization? An overview for clinicians

Research

Problem opioid use and HIV primary care engagement among hospitalized people who use drugs and/or alcohol

Research

Choosing internet-based treatment for problematic alcohol use—why, when and how? Users’ experiences of treatment online

Study Protocol

Video directly observed therapy intervention using a mobile health application among opioid use disorder patients receiving office-based buprenorphine treatment: protocol for a pilot randomized controlled trial

Research

One size doesn’t fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway