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Review
. 2023 Jul;27(7):175-181.
doi: 10.1007/s11916-023-01116-3. Epub 2023 Apr 21.

Low-Dose Initiation of Buprenorphine: A Narrative Review

Amber N Edinoff  1   2 , Omar H Fahmy  3 , Noah J Spillers  4 , Alexa R Zaheri  4 , Eric D Jackson  5 , Audrey J De Witt  6 , Danielle M Wenger  5 , Elyse M Cornett  7   6 , Kimberly L Skidmore  6 , Adam M Kaye  8 , Alan D Kaye  7   6
Affiliations
Review

Low-Dose Initiation of Buprenorphine: A Narrative Review

Amber N Edinoff et al. Curr Pain Headache Rep. 2023 Jul.

Abstract

Purpose of review: Opioid use disorder (OUD) is a chronic disorder in which a person loses control over the use of opioids, develops a compulsive behavior, and defends the use despite knowing the negative consequences. There are numerous treatments for OUD, including buprenorphine. Since it is displacing a full agonist opioid, precipitated withdrawal can occur with standard inductions involving buprenorphine.

Recent findings: Case reports have noted success with a low-dose initiation of buprenorphine, which is different from typical protocols, relatively limited by adverse effects when patients were recently administered full agonists. A cohort investigation studied the use of a transdermal patch as part of the protocol, which was fairly well tolerated. While ongoing research is being conducted on this topic, recent case studies and smaller cohort studies have demonstrated the feasibility of a trial to treat OUD with low-dose initiation of buprenorphine.

Keywords: Addiction treatment; Buprenorphine; Fentanyl; Lose dose; Opioid use disorder; Withdrawal.

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References

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