Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series
Abstract Background Hospitalizations are a vital opportunity for the initiation of life-saving opioid agonist therapy (OAT) for patients with opioid use disorder. A novel approach to OAT initiation is the use of IV buprenorphine for low dose induction, which allows patients to immediately start bupr...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-023-00392-z |
| _version_ | 1797811315741294592 |
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| author | John P. Murray Geoffrey Pucci George Weyer Mim Ari Sarah Dickson Angela Kerins |
| author_facet | John P. Murray Geoffrey Pucci George Weyer Mim Ari Sarah Dickson Angela Kerins |
| author_sort | John P. Murray |
| collection | DOAJ |
| description | Abstract Background Hospitalizations are a vital opportunity for the initiation of life-saving opioid agonist therapy (OAT) for patients with opioid use disorder. A novel approach to OAT initiation is the use of IV buprenorphine for low dose induction, which allows patients to immediately start buprenorphine at any point in a hospitalization without stopping full agonist opioids or experiencing significant withdrawal. Methods This is a retrospective case series of 33 patients with opioid use disorder concurrently treated with full agonist opioids for pain who voluntarily underwent low dose induction at a tertiary academic medical center. Low dose induction is the process of initiating very low doses of buprenorphine at fixed intervals with gradual dose increases in patients who recently received or are simultaneously treated with full opioid agonists. Our study reports one primary outcome: successful completion of the low dose induction (i.e. transitioned from low dose IV buprenorphine to sublingual buprenorphine-naloxone) and three secondary outcomes: discharge from the hospital with buprenorphine-naloxone prescription, self-reported pain scores, and nursing-assessed clinical opiate withdrawal scale (COWS) scores over a 6-day period, using descriptive statistics. COWS and pain scores were obtained from day 0 (prior to starting the low dose induction) to day 5 to assess the effect on withdrawal symptoms and pain control. Results Thirty patients completed the low dose induction (30/33, 90.9%). Thirty patients (30/33, 90.9%) were discharged with a buprenorphine prescription. Pain and COWS scores remained stable over the course of the study period. Mean COWS scores for all patients were 2.6 (SD 2.8) on day 0 and 1.6 (SD 2.6) on day 5. Mean pain scores for all patients were 4.4 (SD 2.1) on day 0 and 3.5 on day 5 (SD 2.1). Conclusions This study found that an IV buprenorphine low dose induction protocol was well-tolerated by a group of 33 hospitalized patients with opioid use disorder with co-occurring pain requiring full agonist opioid therapy. COWS and pain scores improved for the majority of patients. This is the first case series to report mean daily COWS and pain scores over an extended period throughout a low dose induction process. |
| first_indexed | 2024-03-13T07:21:53Z |
| format | Article |
| id | doaj.art-186feda06b114131af7638f8704766bf |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-03-13T07:21:53Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-186feda06b114131af7638f8704766bf2023-06-04T11:35:35ZengBMCAddiction Science & Clinical Practice1940-06402023-06-011811810.1186/s13722-023-00392-zLow dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case seriesJohn P. Murray0Geoffrey Pucci1George Weyer2Mim Ari3Sarah Dickson4Angela Kerins5Department of Medicine, University of ChicagoDepartment of Pharmacology, University of ChicagoDepartment of Medicine, University of ChicagoDepartment of Medicine, University of ChicagoDepartment of Medicine, University of ChicagoDepartment of Pharmacology, University of ChicagoAbstract Background Hospitalizations are a vital opportunity for the initiation of life-saving opioid agonist therapy (OAT) for patients with opioid use disorder. A novel approach to OAT initiation is the use of IV buprenorphine for low dose induction, which allows patients to immediately start buprenorphine at any point in a hospitalization without stopping full agonist opioids or experiencing significant withdrawal. Methods This is a retrospective case series of 33 patients with opioid use disorder concurrently treated with full agonist opioids for pain who voluntarily underwent low dose induction at a tertiary academic medical center. Low dose induction is the process of initiating very low doses of buprenorphine at fixed intervals with gradual dose increases in patients who recently received or are simultaneously treated with full opioid agonists. Our study reports one primary outcome: successful completion of the low dose induction (i.e. transitioned from low dose IV buprenorphine to sublingual buprenorphine-naloxone) and three secondary outcomes: discharge from the hospital with buprenorphine-naloxone prescription, self-reported pain scores, and nursing-assessed clinical opiate withdrawal scale (COWS) scores over a 6-day period, using descriptive statistics. COWS and pain scores were obtained from day 0 (prior to starting the low dose induction) to day 5 to assess the effect on withdrawal symptoms and pain control. Results Thirty patients completed the low dose induction (30/33, 90.9%). Thirty patients (30/33, 90.9%) were discharged with a buprenorphine prescription. Pain and COWS scores remained stable over the course of the study period. Mean COWS scores for all patients were 2.6 (SD 2.8) on day 0 and 1.6 (SD 2.6) on day 5. Mean pain scores for all patients were 4.4 (SD 2.1) on day 0 and 3.5 on day 5 (SD 2.1). Conclusions This study found that an IV buprenorphine low dose induction protocol was well-tolerated by a group of 33 hospitalized patients with opioid use disorder with co-occurring pain requiring full agonist opioid therapy. COWS and pain scores improved for the majority of patients. This is the first case series to report mean daily COWS and pain scores over an extended period throughout a low dose induction process.https://doi.org/10.1186/s13722-023-00392-zOpioid use disorderLow dose inductionOpioid agonist therapyMicroinductionAddiction medicineBuprenorphine |
| spellingShingle | John P. Murray Geoffrey Pucci George Weyer Mim Ari Sarah Dickson Angela Kerins Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series Addiction Science & Clinical Practice Opioid use disorder Low dose induction Opioid agonist therapy Microinduction Addiction medicine Buprenorphine |
| title | Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series |
| title_full | Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series |
| title_fullStr | Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series |
| title_full_unstemmed | Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series |
| title_short | Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series |
| title_sort | low dose iv buprenorphine inductions for patients with opioid use disorder and concurrent pain a retrospective case series |
| topic | Opioid use disorder Low dose induction Opioid agonist therapy Microinduction Addiction medicine Buprenorphine |
| url | https://doi.org/10.1186/s13722-023-00392-z |
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