Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis
Abstract Background Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-022-00336-z |
| _version_ | 1828161173279735808 |
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| author | Adams K. K. Miech E. J. Sobieraj D. M. |
| author_facet | Adams K. K. Miech E. J. Sobieraj D. M. |
| author_sort | Adams K. K. |
| collection | DOAJ |
| description | Abstract Background Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following question: when patients received a buprenorphine initiation strategy aimed to eliminate prerequisite withdrawal, what factors consistently distinguished patients that experienced withdrawal during the initiation process from patients that did not? Methods From the 24 cases identified by our systematic review, we included cases that were treated using buprenorphine microdosing strategies (oral or transdermal), cases with opioid use disorder, and cases that fully transitioned to buprenorphine without continuing the full opioid agonist. Configurational analysis was used to identify combinations of patient and regimen level factors that uniquely distinguished cases experiencing withdrawal during induction. Result Fourteen cases were included in our analysis, of which 9 experienced opioid withdrawal symptoms. Three factors were involved in explaining both the presence and absence of withdrawal symptoms: history of heroin use, history of methadone use, and duration of overlap between buprenorphine and the full opioid agonist during induction. For the presence of withdrawal symptoms, the addition of a fourth factor “buprenorphine starting dose” resulted in a model with perfect consistency and coverage; for the absence of withdrawal symptoms, the addition of a fourth factor “induction duration” similarly resulted in a model with perfect consistency and 80% coverage. Conclusion Application of configurational methods allowed synthesis of case reports identified through a systematic review. |
| first_indexed | 2024-04-12T00:34:18Z |
| format | Article |
| id | doaj.art-9ec852bc4d244b698cdd32b82728bf88 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-04-12T00:34:18Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-9ec852bc4d244b698cdd32b82728bf882022-12-22T03:55:12ZengBMCAddiction Science & Clinical Practice1940-06402022-10-011711710.1186/s13722-022-00336-zFactors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysisAdams K. K.0Miech E. J.1Sobieraj D. M.2University of Connecticut School of PharmacyRegenstrief Institute, Center for Health Services ResearchUniversity of Connecticut School of PharmacyAbstract Background Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following question: when patients received a buprenorphine initiation strategy aimed to eliminate prerequisite withdrawal, what factors consistently distinguished patients that experienced withdrawal during the initiation process from patients that did not? Methods From the 24 cases identified by our systematic review, we included cases that were treated using buprenorphine microdosing strategies (oral or transdermal), cases with opioid use disorder, and cases that fully transitioned to buprenorphine without continuing the full opioid agonist. Configurational analysis was used to identify combinations of patient and regimen level factors that uniquely distinguished cases experiencing withdrawal during induction. Result Fourteen cases were included in our analysis, of which 9 experienced opioid withdrawal symptoms. Three factors were involved in explaining both the presence and absence of withdrawal symptoms: history of heroin use, history of methadone use, and duration of overlap between buprenorphine and the full opioid agonist during induction. For the presence of withdrawal symptoms, the addition of a fourth factor “buprenorphine starting dose” resulted in a model with perfect consistency and coverage; for the absence of withdrawal symptoms, the addition of a fourth factor “induction duration” similarly resulted in a model with perfect consistency and 80% coverage. Conclusion Application of configurational methods allowed synthesis of case reports identified through a systematic review.https://doi.org/10.1186/s13722-022-00336-zOpioid use disorderBuprenorphineConfigurational comparative methodsSystematic review |
| spellingShingle | Adams K. K. Miech E. J. Sobieraj D. M. Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis Addiction Science & Clinical Practice Opioid use disorder Buprenorphine Configurational comparative methods Systematic review |
| title | Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis |
| title_full | Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis |
| title_fullStr | Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis |
| title_full_unstemmed | Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis |
| title_short | Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis |
| title_sort | factors that distinguish opioid withdrawal during induction with buprenorphine microdosing a configurational analysis |
| topic | Opioid use disorder Buprenorphine Configurational comparative methods Systematic review |
| url | https://doi.org/10.1186/s13722-022-00336-z |
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