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Workshop: Induction without Withdrawal: Low-Dose Buprenorphine Inductions

Buprenorphine is a recommended treatment for opioid use disorder due to its similar efficacy and superior safety profile compared to other opioid agonist treatment medications. However, because of its high binding affinity at μ-opioid receptors (μORs) and its high lipophilicity, buprenorphine abruptly displaces other opioids from μORs and has persistent but lower intrinsic efficacy at brain μORs compared with full agonists, which can lead to precipitated withdrawal. To avoid this outcome, patients are instructed to abstain from opioids and experience at least moderate withdrawal before initiating buprenorphine. This requirement of prior withdrawal and risk of precipitated withdrawal, which can lead to treatment dropout, relapse with unregulated opioids, and subsequent overdose, are major barriers to buprenorphine use among patients and healthcare staff. Low-dose inductions (also known as micro-dosing, micro-inductions) involve the administration of small, frequent does of buprenorphine negating the need for a period of withdrawal and opioid abstinence prior to the start of treatment and aims to reduce the risk of precipitated withdrawal. Building upon the Bernese method, we have developed novel, more rapid methods of low-dose buprenorphine inductions involving sublingual, transdermal, and subcutaneous formulations. Utilizing practical real-life cases as well as patient testimonial videos, we will teach low-dose induction techniques (low-dose induction, rapid low-dose induction, ultra-rapid low-dose induction, rapid transdermal buprenorphine induction onto buprenorphine/naloxone and buprenorphine extended-release) for varied patient populations (e.g., chronic pain, geriatric, child and adolescent) and clinical scenarios (e.g., mechanically ventilated patient, inpatient and outpatient settings).

Learning Objectives
  • Utilize sublingual buprenorphine/naloxone low-dose inductions in inpatient and outpatient settings.
  • Utilize buprenorphine/naloxone low-dose inductions in the chronic pain/prescription opioid tolerant setting and in varied populations, such as geriatric patients, youth, and adolescents.
  • Utilize transdermal buprenorphine to rapidly initiate patients onto buprenorphine/naloxone and buprenorphine extended-release.
Keywords / Topics
  • Buprenorphine
  • Low-dose inductions
  • Transdermal
James Wong, Chairperson 
James Wong, MSc is a Clinical Research Manager with the Complex Pain and Addiction Service of Vancouver General Hospital, Vancouver, British Columbia, Canada.  

Martha Ignaszewski  MD, Co-Chair and Presenter

Dr. Martha J Ignaszewski is a Harvard and UCSF-trained psychiatrist with board certification in Adult, Addiction, and Child and Adolescent Psychiatry in Canada and the USA. She is one of 100 physicians with this subspecialty training and clinical experience in the USA.  
Pouya Azar, MD, Presenter

Pouya Azar, MD, FRCPC, DABAM, is the Head of the Complex Pain and Addiction Service (CPAS), a consult service under the Department of Psychiatry at Vancouver Coastal Health, British Columbia, Canada, which provides management of pain, mental health disorders, and substance use disorders across all clinical services at Vancouver General Hospital (VGH), University of British Columbia (UBC) Hospital, and GF Strong Rehabilitation Centre.

Nickie Mathew, MD, Presenter

Dr. Nick Mathew currently serves as the Medical Director of Complex Mental Health and Substance Use Services at the Provincial Health Services Authority in British Columbia, Canada. 
Availability: On-Demand
Cost: FREE
Credit Offered:
0.75 CME Credit
0.75 Other Professionals Credit
American Academy of Addiction Psychiatry
The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.

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