Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep-Oct;17(5):521-527.
doi: 10.1097/ADM.0000000000001163. Epub 2023 Mar 28.

Survey of Buprenorphine Low-dose Regimens Used by Healthcare Institutions

Monika Hardy  1 , Samantha Grable, Rachel Otley, Michelle Pershing
Affiliations

Survey of Buprenorphine Low-dose Regimens Used by Healthcare Institutions

Monika Hardy et al. J Addict Med. 2023 Sep-Oct.

Abstract

Background: Buprenorphine microdosing ("low-dosing") allows for initiation of buprenorphine without requiring patients to endure withdrawal. Case studies suggest its favorable utility as an alternative to conventional buprenorphine induction. However, published regimens vary in duration, dosage forms used, and timing of full opioid agonist discontinuation.

Methods: This cross-sectional survey study sought to determine how buprenorphine low-dosing is approached by medical institutions across the United States. The primary end point was characterization of inpatient buprenorphine low-dosing regimens. Situations and types of patients in which low-dosing is used and obstacles to institutional protocol development were also collected. An online survey was disseminated through professional pharmacy organizations and personal contacts. Responses were collected over 4 weeks.

Results: Twenty-three unique protocols were collected from 25 institutions. Most protocols used buccal (8 protocols) or transdermal (8 protocols) buprenorphine as first doses before transitioning to sublingual buprenorphine. The most common starting doses were buprenorphine 20 μg/h transdermal, 150 μg buccal, and 0.5 mg sublingual. Patients unable to tolerate conventional buprenorphine induction or those who potentially used fentanyl nonmedically were most likely to be prescribed low-dosing. The most common obstacle to developing an internal low-dosing protocol was lack of existing consensus guidelines.

Conclusions: Similar to published regimens, internal protocols are variable. Buccal first doses may be used more commonly in practice based on survey results, while transdermal first doses are more commonly reported in publications. More research is needed to determine whether differences in starting formulations impact safety and efficacy of buprenorphine low-dosing in the inpatient setting.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Results from the 2020. National Survey on Drug Use and Health: Detailed Tables. https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables . Accessed November 13, 2022.
    1. Mariolis T, Bosse J, Martin S, et al. A systematic review of the effectiveness of buprenorphine for opioid use disorder compared to other treatments: Implications for research and practice. J Addict Res Ther . 2019;10(2):379.
    1. Substance Abuse and Mental Health Services Administration. Removal of DATA Waiver (X-Waiver) requirement. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-... . Accessed February 8, 2023.
    1. De Aquino JP, Parida S, Sofuoglu M. The pharmacology of buprenorphine microinduction for opioid use disorder. Clin Drug Investig . 2021;41(5):425–436.
    1. Weimer MB, Fiellin DA. Low- and very low-dose buprenorphine induction: New(ish) uses for an old(ish) medication? Addiction . 2022;117(6):1507–1509.