If you need support or linkage to care after your emergency department, hospital, or clinic visit, call the CareConnect Warmline at 484-278-1679 to speak with a substance use navigator.
Buprenorphine is a mu-opioid receptor partial agonist that is indicated for pain management and the treatment of opioid use disorder (OUD). Traditional induction for patients with OUD requires a patient to experience opioid withdrawal (measured via the COWS score) prior to buprenorphine initiation. This is necessary in order to prevent the experience of precipitated withdrawal due to the partial agonist effects in the setting of a full opioid agonist when using high doses of buprenorphine (mg doses). Micro-dosing of buprenorphine uses microgram (mcg) doses, allowing for the induction of buprenorphine without the need to first experience withdrawal or the risk of precipitated withdrawal given the very small doses. In the inpatient setting, this can be accomplished through several formulations of buprenorphine that can be given in micrograms — buccal films (Belbuca®), patches (Butrans®), and intravenous buprenorphine. In the outpatient setting, this can be accomplished through cutting of sublingual films into smaller pieces. Doses are increased over 3-7 days to achieve full maintenance dosing.
For use as an alternative to standard or higher-dose buprenorphine induction strategies
Who wish to avoid the need for moderate-severe withdrawal symptoms prior to induction with higher doses of buprenorphine.