Buprenorphine Microdose Induction for the Management of Prescription Opioid Dependence

Jonathan L. Robbins; Honora Englander; Jessica Gregg

doi:10.3122/jabfm.2021.S1.200236

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Table 1.

Demographics and Clinical Features of Patients Who Underwent Sublingual Buprenorphine Microdose Induction from November 2019 to April 2020

Patient	Age (y)	Gender	Full Agonist Opioid at Time of Induction	MEDD (mg)	Substance Use Disorder (by DSM-V)	Psychological/Medical Comorbidity	Pain Generators	Maintenance SL Buprenorphine Dosage at 30 days
1	53	Female	Fentanyl 100 μg	240	None	Rheumatoid arthritis; paroxysmal atrial fibrillation, major depressive disorder	Rheumatoid arthritis	4 mg – 8 mg – 8 mg
2	67	Male	Hydrocodone/acetaminophen 10–325 mg 8 per day	80	None	None	Shoulder, knee, cervical, lumbar osteoarthritis	Not applicable; unable to tolerate buprenorphine 2 mg due to oversedation; back on full agonist at previous dose
3	69	Male	Oxycodone 30 mg 5 times per day	225	Benzodiazepine use disorder, mild	Major depressive disorder, hypogonadism, paroxysmal atrial fibrillation	Failed back surgery syndrome	8 mg 3 times daily and continues on oxycodone 15 mg 3 times daily on slow taper
4	62	Female	Oxycodone 10 mg 5 times per day	75	Alcohol use disorder, moderate	Bipolar 2 disorder	Chronic pancreatitis, chronic abdominal pain	Not applicable; unable to tolerate buprenorphine due to nausea; switched back to full agonist, slowly tapering
5	63	Female	Methadone 10 mg twice daily; hydromorphone 2 mg 4 times daily	92	Opioid use disorder, mild	Major depressive disorder, adrenal insufficiency, benzodiazepine dependence	Fibromyalgia, knee osteoarthritis	4 mg 4 times daily
6	67	Male	Hydromorphone 4 mg 5 times daily; morphine extended release 15 mg daily	95	Opioid use disorder, mild	Parkinson’s disease, severe odynophagia	Multiple orthopedic surgeries, Parkinson’s disease	8 mg 3 times daily
7	70	Female	Morphine extended release 30 mg twice daily; morphine immediate release 15 mg 3 times daily	105	None	Major depressive disorder	Neuropathy, fibromyalgia, knee osteoarthritis	8 mg 3 times daily
8	53	Male	Oxycodone 10 mg 7 times daily	105	None	Ischemic heart failure, uncontrolled type 2 diabetes mellitus	Chronic leg wounds, lumbar spine osteoarthritis	8 mg twice daily

DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition; MEDD, morphine equivalent daily dose.

Table 2. Outpatient Microinduction Protocol Using Sublingual 2 mg Buprenorphine/Naloxone Tablets or Films

Day	Bup/Nlx Dose and Frequency	Full Agonist Opioid
1	0.5 mg daily (1/4 tablet or film)	No change
2	0.5 mg BID	No change
3	1 mg BID (half-tablet or film)	No change
4	2 mg BID	No change
5	2 mg TID	No change
6	4 mg TID	No change
7 and beyond	Per provider discretion	Taper by 25% weekly