Department of Pharmacy Services, University of Michigan Health, Ann Arbor, Michigan, USA.
University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
Pharmacotherapy. 2022 May;42(5):411-427. doi: 10.1002/phar.2676. Epub 2022 Mar 25.
Buprenorphine possesses many unique attributes that make it a practical agent for adults and adolescents with opioid use disorder (OUD) and/or acute or chronic pain. Sublingual buprenorphine has been the standard of care for treating OUD, but its use in pain management is not as clearly defined. Current practice guidelines recommend a period of mild-to-moderate withdrawal from opioids before transitioning to buprenorphine due to its ability to displace full agonists from the μ-opioid receptor. However, this strategy can lead to negative physical and psychological outcomes for patients. Novel initiation strategies suggest that concomitant administration of small doses of buprenorphine with opioids can avoid the unwanted withdrawal associated with buprenorphine initiation. We aim to systematically review the buprenorphine initiation strategies that have emerged in the last decade. Embase, PubMed, and Cochrane Databases were searched for relevant literature. Studies were included if they were published in the English language and described the transition to buprenorphine from opioids. Data were collected from each study and synthesized using descriptive statistics. This review included 7 observational studies, 1 feasibility study, and 39 case reports/series which included 924 patients. The strategies utilized between the literature included traditional initiation (47.9%), microdosing with various buprenorphine formulations (16%), and miscellaneous methods (36.1%). Traditional initiation and microdosing initiation were compared in the data synthesis and analysis; miscellaneous methods were omitted given the high variability between methods. Overall, 95.6% of patients in the traditional initiation group and 96% of patients in the microdosing group successfully rotated to sublingual buprenorphine. Initiation regimens can vary widely depending on patient-specific factors and buprenorphine formulation. A variety of buprenorphine transition strategies are published in the literature, many of which were effective for patients with OUD, pain, or both.
丁丙诺啡具有许多独特的属性，使其成为治疗阿片类药物使用障碍（OUD）和/或急性或慢性疼痛的成年和青少年的实用药物。舌下丁丙诺啡一直是治疗 OUD 的标准治疗方法，但在疼痛管理中的应用却没有明确界定。由于其能够从μ-阿片受体上置换完全激动剂，当前的实践指南建议在转换为丁丙诺啡之前，让患者经历一段轻度至中度的阿片类药物戒断期。然而，这种策略可能会给患者带来负面的生理和心理后果。新的起始策略表明，同时给予小剂量丁丙诺啡和阿片类药物可以避免与丁丙诺啡起始相关的不必要戒断。我们旨在系统地回顾过去十年中出现的丁丙诺啡起始策略。检索了 Embase、PubMed 和 Cochrane 数据库中的相关文献。如果研究以英文发表，并描述了从阿片类药物转换为丁丙诺啡，则将其纳入研究。从每项研究中收集数据，并使用描述性统计进行综合。本综述包括 7 项观察性研究、1 项可行性研究和 39 项病例报告/系列，共纳入 924 名患者。文献中使用的策略包括传统起始（47.9%）、各种丁丙诺啡制剂的微剂量（16%）和各种其他方法（36.1%）。在数据综合和分析中比较了传统起始和微剂量起始；由于方法之间存在很大的差异，因此省略了其他方法。总体而言，传统起始组 95.6%的患者和微剂量组 96%的患者成功转为舌下丁丙诺啡。起始方案可能因患者具体情况和丁丙诺啡制剂而异而有很大差异。文献中发表了许多丁丙诺啡转换策略，其中许多对 OUD、疼痛或两者都有效的患者有效。
