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 COWS scores) 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 the buprenorphine buccal films (Belbuca®), which are dosed in micrograms, allowing for the induction of buprenorphine without the need to first experience withdrawal or the risk of precipitated withdrawal given the very small doses. Doses are increased over 3-4 days to achieve full maintenance dosing. Case reports and case series support this approach in hospital settings, and we have successfully completed buprenorphine induction using this approach in two patients at HUP.
For use as an alternative to standard or higher-dose buprenorphine induction strategies
Who wish to avoid the need for moderate withdrawal symptoms prior to induction with higher doses of buprenorphine.