Low-dose Buprenorphine Initiation in Hospitalized Adults With Opioid Use Disorder: A Retrospective Cohort Analysis.
Journal
Journal of addiction medicine
ISSN: 1935-3227
Titre abrégé: J Addict Med
Pays: Netherlands
ID NLM: 101306759
Informations de publication
Date de publication:
Historique:
pubmed:
19
5
2021
medline:
22
3
2022
entrez:
18
5
2021
Statut:
ppublish
Résumé
Patients with opioid use disorder (OUD) can initiate buprenorphine without requiring a withdrawal period through a low-dose (sometimes referred to as "micro-induction") approach. Although there is growing interest in low-dose buprenorphine initiation, current evidence is limited to case reports and small case series. We performed a retrospective cohort study of patients with OUD seen by a hospital-based addiction medicine consult service who underwent low-dose buprenorphine initiation starting during hospital admission. We then integrated our practice-based experiences with results from the existing literature to create practice considerations. Sixty-eight individuals underwent 72 low-dose buprenorphine initiations between July 2019 and July 2020. Reasons for low-dose versus standard buprenorphine initiation included co-occurring pain (91.7%), patient anxiety around the possibility of withdrawal (69.4%), history of precipitated withdrawal (9.7%), opioid withdrawal intolerance (6.9%), and other reason/not specified (18.1%). Of the 72 low-dose buprenorphine initiations, 50 (69.4%) were completed in the hospital, 9 (12.5%) transitioned to complete as an outpatient, and 13 (18.1%) were terminated early. We apply our experiences and findings from literature to recommendations for varied clinical scenarios, including acute illness, co-occurring pain, opioid withdrawal intolerance, transition from high dose methadone to buprenorphine, history of precipitated withdrawal, and rapid hospital discharge. We share a standard low-dose initiation protocol with potential modifications based on above scenarios. Low-dose buprenorphine initiation offers a well-tolerated and versatile approach for hospitalized patients with OUD. We share lessons from our experiences and the literature, and provide practical considerations for providers.
Identifiants
pubmed: 34001775
doi: 10.1097/ADM.0000000000000864
pii: 01271255-202204000-00026
pmc: PMC8595358
mid: NIHMS1694730
doi:
Substances chimiques
Analgesics, Opioid
0
Buprenorphine
40D3SCR4GZ
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e105-e111Subventions
Organisme : NIDA NIH HHS
ID : UG1 DA015815
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002369
Pays : United States
Informations de copyright
Copyright © 2021 American Society of Addiction Medicine.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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