Addition Medicine Fellowship, University of Colorado Hospital, CeDAR, Aurora, Colorado.
Department of Medicine, Hospital Medicine, University of Colorado Hospital, Aurora, Colorado.
Pharmacotherapy. 2019 Oct;39(10):1023-1029. doi: 10.1002/phar.2313. Epub 2019 Aug 15.
Buprenorphine, a partial μ-opioid agonist, is an effective treatment for opioid use disorder that conventionally requires symptoms of withdrawal before initiation to avoid precipitating withdrawal. Our institution implemented a microdosing approach to transition patients from full μ-opioid agonists to buprenorphine without requiring patients to undergo a period of opioid abstinence. Little has been published about this strategy in the inpatient setting in the United States, and even less has been published dealing with the transition from methadone to buprenorphine. Our objective was to demonstrate that a microdosing protocol to transition patients from methadone to buprenorphine can be feasibly implemented in a U.S. hospital setting.
Case series.
Three hospitalized adults with opioid use disorder who received a 1-week buprenorphine microdosing protocol.
In January 2019, we implemented a 1-week buprenorphine microdosing protocol for hospitalized adult patients with opioid use disorder who were initially stabilized on methadone and wished to start buprenorphine. We gave low-dose buprenorphine concurrently with each patient's full dose of methadone, and the buprenorphine dose was gradually titrated up over 7 days. On day 8, methadone was abruptly discontinued. The buprenorphine dose was further increased based on clinical judgment. All three patients were successfully transitioned from methadone 40-100 mg/day to buprenorphine 12-16 mg/day with minimal symptoms of opioid withdrawal. One patient relapsed and was lost to follow-up; two remained in treatment.
A protocol using microdosing of buprenorphine can successfully transition patients receiving full μ-opioid agonist therapy, including methadone, to buprenorphine without the need for a period of opioid abstinence.
丁丙诺啡是一种部分μ-阿片受体激动剂，对阿片类药物使用障碍有很好的治疗效果，通常需要在开始治疗前出现戒断症状，以避免诱发戒断。我们医院实施了一种微剂量转换方案，使接受全μ-阿片受体激动剂治疗的患者无需经历阿片类药物戒断期即可转为丁丙诺啡治疗。在美国，很少有关于这种方案在住院环境下应用的报道，更少涉及从美沙酮转为丁丙诺啡的报道。我们的目的是证明在美沙酮转为丁丙诺啡的过程中采用微剂量转换方案在美国家庭医院是可行的。
病例系列研究。
3 名住院的阿片类药物使用障碍患者，他们接受了为期 1 周的丁丙诺啡微剂量方案治疗。
2019 年 1 月，我们为最初接受美沙酮稳定治疗且希望开始使用丁丙诺啡的住院成年阿片类药物使用障碍患者实施了为期 1 周的丁丙诺啡微剂量方案。我们给患者低剂量的丁丙诺啡，并同时给予患者全剂量的美沙酮，然后在 7 天内逐渐增加丁丙诺啡的剂量。第 8 天，突然停止使用美沙酮。根据临床判断进一步增加丁丙诺啡的剂量。所有 3 名患者均成功地从美沙酮 40-100mg/天转换为丁丙诺啡 12-16mg/天，仅有轻微的阿片类戒断症状。1 名患者复发并失去随访，2 名患者继续接受治疗。
使用丁丙诺啡微剂量方案可以成功地将接受全μ-阿片受体激动剂治疗（包括美沙酮）的患者转换为丁丙诺啡，而无需经历阿片类药物戒断期。
