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Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach

Authors
  • Rozylo, Jennifer1
  • Mitchell, Keren1, 2, 3, 4
  • Nikoo, Mohammadali1, 1
  • Durante, S. Elise2, 3
  • Barbic, Skye P.1, 2, 3, 4, 5, 1
  • Lin, Daniel1, 2, 3, 4
  • Mathias, Steve1, 2, 3, 4, 5
  • Azar, Pouya1, 2, 3, 4, 6
  • 1 University of British Columbia, Vancouver, BC, Canada , Vancouver (Canada)
  • 2 Providence Health Care, Vancouver, BC, Canada , Vancouver (Canada)
  • 3 Foundry, Providence Health Care, Vancouver, BC, Canada , Vancouver (Canada)
  • 4 St Paul’s Hospital, Vancouver, BC, Canada , Vancouver (Canada)
  • 5 Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada , Vancouver (Canada)
  • 6 Vancouver General Hospital, DHCC, Floor 8-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada , Vancouver (Canada)
Type
Published Article
Journal
Addiction Science & Clinical Practice
Publisher
BioMed Central
Publication Date
Jan 15, 2020
Volume
15
Issue
1
Identifiers
DOI: 10.1186/s13722-020-0177-x
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction.Case presentationWe aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual’s opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks.ConclusionsA microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.

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