Author/Authors :
Rozylo, Jennifer University of British Columbia, Vancouver, Canada , Mitchell, Keren University of British Columbia, Vancouver, Canada , Nikoo, Mohammadali University of British Columbia, Vancouver, Canada , Durante, S. Elise University of British Columbia, Vancouver, Canada , Barbic, Skye P. University of British Columbia, Vancouver, Canada , Lin, Daniel University of British Columbia, Vancouver, Canada , Mathias, Steve University of British Columbia, Vancouver, Canada , Azar, Pouya University of British Columbia, Vancouver, Canada
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.
Keywords :
Opioid use disorder , Buprenorphine/naloxone , Microdosing , Bernese method , Induction method
