Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder - a case report

TL;DR

A patient successfully transitioned from high-dose methadone to buprenorphine using a microdose method, avoiding withdrawal symptoms.

Contribution

The case demonstrates a successful transition to buprenorphine depot using microdosing in a high-dose methadone patient.

Findings

Microdosing enabled a smooth transition from methadone to sublingual buprenorphine without withdrawal symptoms.

The patient was successfully switched to a weekly buprenorphine depot formulation.

This approach may be useful for patients on high methadone doses who cannot tolerate traditional buprenorphine induction.

Abstract

Opioid dependence is a complex condition that often requires long-term treatment and care. Methadone, a synthetic full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are most commonly used for substitution therapy of opioid dependence and typically administered orally as a liquid and sublingual tablets. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Microdose induction is proposed as a possible solution to ease the transition to buprenorphine.

To present a rapid transition from methadone to sublingual buprenorphine and after that to buprenorphine depot.

A case report of a patient who was switched from methadone 60 mg to sublingual buprenorphine 8 mg using microdosing and after that switched to buprenorphine depo 16 mg weekly.

Patient was successfully switched to sublingual buprenorphine and after that to buprenorphine depot. The transition was complited without withdrawal simptoms.

This report supports the use of a microdose induction to initiate buprenorphine. Additionally, this approach may be significant for patients stabilized on high doses of methadone who may not be able to tolerate a traditional buprenorphine induction.

None Declared