Department of Addiction Psychiatry, Boston University Medical Center, Boston, Massachusetts.
VA Boston Healthcare System, Massachusetts.
Am J Addict. 2021 Jul;30(4):305-315. doi: 10.1111/ajad.13135. Epub 2020 Dec 30.
Buprenorphine's high-binding affinity as a partial µ-opioid agonist displaces preexisting full agonists causing precipitated withdrawal, which requires most individuals starting buprenorphine to endure moderate withdrawal prior to induction to avoid precipitated withdrawal. A novel approach called microinduction has emerged to remove this prerequisite. Our aim is to review the literature on these alternative approaches.
Using keywords including buprenorphine, buprenorphine/naloxone, transdermal buprenorphine, suboxone, microinduction, microdosing, rapid induction, buprenorphine-dosing protocol, the authors searched PubMed/Medline, EMBASE, PsycINFO, PsychARTICLES, and Scopus databases from the date of inception through April 30, 2020, which yielded 1726 results, which, in turn, after manual exclusion for irrelevant content and publication in languages other than English, generated a total of 18 papers.
On the basis of 18 papers included in this review, 63 patients were successfully transitioned to buprenorphine using different microdosing techniques, primarily in the inpatient setting. From the available data, patients were transitioned from a variety of opioids over a range of dosing without significant withdrawal, and initial doses ranged most frequently from 0.2 to 0.5 mg. While the timeframe for the various schedules ranged from 3 to 112 days, most transitioned over a period of 4 to 8 days, and most participants completed the cross titration at 8 to 16 mg.
The growing literature demonstrates some initial promise for alternative induction models, specifically targeting patients averse to withdrawal, patients prescribed opioids for chronic pain, patients on high-dose methadone, and patients using illicit or pharmaceutical fentanyl.
This manuscript provides a review of the existing literature to help clinicians better understand the approaches to microdosing of buprenorphine in various clinical settings and populations. (Am J Addict 2020;00:00-00).
丁丙诺啡作为一种部分μ-阿片激动剂，与先前存在的完全激动剂具有高结合亲和力，导致戒断症状加剧，这就要求大多数开始使用丁丙诺啡的个体在诱导前忍受适度戒断，以避免戒断症状加剧。一种新的方法称为微诱导已经出现，以消除这一前提。我们的目的是综述这些替代方法的文献。
使用包括丁丙诺啡、丁丙诺啡/纳洛酮、透皮丁丙诺啡、苏内奥、微诱导、微剂量、快速诱导、丁丙诺啡剂量方案等关键词，作者检索了 PubMed/Medline、EMBASE、PsycINFO、PsychARTICLES 和 Scopus 数据库，检索时间为起始日期至 2020 年 4 月 30 日，共获得 1726 项结果，然后手动排除不相关的内容和非英文出版物，最终共有 18 篇论文纳入本综述。
根据本综述中纳入的 18 篇论文，63 例患者成功地使用不同的微剂量技术过渡到丁丙诺啡治疗，主要是在住院环境下。根据现有数据，患者从各种阿片类药物过渡到不同剂量，没有明显戒断，初始剂量最常为 0.2 至 0.5mg。虽然各种方案的时间范围从 3 天到 112 天不等，但大多数患者在 4 至 8 天内完成过渡，大多数患者在 8 至 16mg 时完成交叉滴定。
越来越多的文献表明，替代诱导模型具有一定的初步前景，特别是针对那些对戒断反应有抵触情绪的患者、接受慢性疼痛阿片类药物治疗的患者、使用高剂量美沙酮的患者和使用非法或药物芬太尼的患者。
本文综述了现有的文献，有助于临床医生更好地理解丁丙诺啡在各种临床环境和人群中的微剂量方法。
