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35th AM (2025) - Poster Session
Outpatient Initiation of Low-Dose Buprenorphine Du ...
Outpatient Initiation of Low-Dose Buprenorphine During Acute Maniain an Older Adult
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Pdf Summary
This case report illustrates the successful outpatient initiation of low-dose buprenorphine induction (LDBI) in a complex 64-year-old male patient with severe opioid use disorder (OUD), cocaine use disorder, schizoaffective disorder, bipolar type, PTSD, and other social and medical challenges. The patient had poor adherence to existing visiting nurse association (VNA) services and psychiatric medications, along with ongoing fentanyl use that elevated risk for precipitated withdrawal with standard buprenorphine induction.<br /><br />A novel seven-day LDBI protocol was implemented, gradually increasing buprenorphine/naloxone doses from 0.5 mg to 16 mg daily (see Table 1), allowing for continued opioid use initially to reduce withdrawal risk. Twice daily VNA visits were arranged to administer the medication, monitor withdrawal symptoms, and support adherence. After dose optimization at day 8 (12 mg-4 mg twice daily), VNA visits were reduced to once daily. The patient tolerated buprenorphine well without adjunct medications, leading to decreased illicit opioid use and improvements in psychiatric symptoms. Despite a brief one-month relapse associated with reduced VNA adherence, the patient re-engaged successfully with VNA support, maintaining treatment over three months.<br /><br />This case highlights the importance of multidisciplinary collaboration, particularly with community services like VNA, to enhance adherence and safety in outpatient LDBI for high-risk patients with severe psychiatric comorbidities and unstable social situations. The approach supports LDBI use outside inpatient settings, addressing challenges due to fentanyl prevalence and complex psychiatric presentations.<br /><br />The study contributes to emerging evidence advocating for alternative outpatient buprenorphine initiation strategies that mitigate precipitated withdrawal risk and accommodate patients’ psychosocial barriers. Clear communication and patient education enabled treatment acceptance despite severe mania and other barriers. Overall, this report suggests that incorporating nursing support can improve LDBI outcomes in difficult-to-treat populations.
Keywords
low-dose buprenorphine induction
opioid use disorder
fentanyl
visiting nurse association
schizoaffective disorder
bipolar disorder
PTSD
outpatient treatment
precipitated withdrawal
multidisciplinary collaboration
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