Workshop: Induction without Withdrawal: Low-Dose Buprenorphine Inductions-Induction without Withdrawal: Low-Dose Buprenorphine Inductions

Induction without Withdrawal: Low-Dose Buprenorphine Inductions

Pdf Summary

During the AAAP 2023 conference, a presentation was given on the topic of low-dose buprenorphine inductions for opioid use disorder (OUD) treatment. The presenters discussed various strategies for using sublingual buprenorphine/naloxone in inpatient and outpatient settings, as well as in different populations such as geriatric patients, youth, and adolescents. They also highlighted the use of transdermal buprenorphine for rapid initiation onto buprenorphine/naloxone and buprenorphine extended-release.<br /><br />The presenters emphasized the pharmacological properties of buprenorphine, including its high affinity for µ-opioid receptors and its partial agonist activity. They explained that buprenorphine has a slow rate of dissociation from the µ-opioid receptor and a long duration of action. The duration of action is dose-dependent, with low doses lasting 4-12 hours, moderate doses lasting 24 hours, and higher doses lasting 2-3 days. Buprenorphine also acts as an antagonist at the kappa-opioid receptor, which may contribute to its antidepressant and antihyperalgesic effects.<br /><br />Various induction strategies were discussed, including waiting for the patient to go into withdrawal, inducing withdrawal via naloxone and rescue with buprenorphine, and low-dose induction techniques such as the Bernese Method and rapid low-dose induction protocols. The presenters also discussed the use of buprenorphine extended-release and the practical considerations and challenges associated with these induction methods.<br /><br />Several case studies were presented to illustrate the effectiveness and feasibility of these low-dose induction strategies in different patient populations, including a youth with severe OUD and a patient requiring rapid induction onto buprenorphine extended-release. The presenters concluded that rapid low-dose inductions can facilitate inpatient buprenorphine induction within a few days, reduce barriers to treatment adherence, and offer a viable option for patients with difficulty adhering to longer induction protocols.<br /><br />Overall, the presentation provided valuable insights into the use of low-dose buprenorphine inductions as a method for initiating buprenorphine/naloxone treatment for OUD. The strategies discussed have the potential to improve patient outcomes and address the growing challenges associated with the use of opioids in the current clinical landscape.

Keywords

low-dose buprenorphine

opioid use disorder

sublingual buprenorphine/naloxone

induction strategies

transdermal buprenorphine

buprenorphine extended-release

pharmacological properties

duration of action

rapid low-dose induction

patient outcomes

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