Low-dose buprenorphine initiation in the era of fentanyl and fentanyl analogs: A case series of outpatient inductions

Saeed Ahmed; Zeeshan Faruqui; Karuna Poddar; Siddhi Bhivandkar; Joji Suzuki

doi:10.5055/jom.0819

Authors

Saeed Ahmed, MD
Zeeshan Faruqui, MD, FAPA
Karuna Poddar, MD, MS
Siddhi Bhivandkar, MD
Joji Suzuki, MD

DOI:

https://doi.org/10.5055/jom.0819

Keywords:

buprenorphine, naloxone, microinduction, microdosing, buprenorphine/naloxone, low-dose buprenorphine

Abstract

Buprenorphine, a partial opioid agonist, is a Food and Drug Administration-approved medication for the treatment of opioid use disorder (OUD). However, due to its high binding affinity, precipitated withdrawal may occur if initiated in the presence of other opioids. The growing literature demonstrates promise for alternative induction model of low-dose initiation of buprenorphine for the treatment of OUD, specifically targeting patients averse to withdrawal or using fentanyl. In this case series, we present four clinical cases of outpatient inductions, in which three out of four successfully transitioned from fentanyl to buprenorphine, and one patient transitioned from methadone to buprenorphine using a low-dose induction method.

Author Biographies

Saeed Ahmed, MD

Department of Psychiatry, Rutland Regional Medical Center, Rutland, Vermont

Zeeshan Faruqui, MD, FAPA

Interventional Psychiatry, Keystone Behavioral Health, Chambersburg, Pennsylvania

Karuna Poddar, MD, MS

Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Siddhi Bhivandkar, MD

Department of Psychiatry, St. Elizabeth’s Medical Center/Boston University, Boston, Massachusetts

Joji Suzuki, MD

Department of Psychiatry, Brigham and Women’s Hospital; Harvard Medical School, Boston, Massachusetts

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