(67) Buprenorphine Rapid Microdosing for Opioid Use Disorder Treatment in the Outpatient Setting

Background
Fear and risk of precipitated withdrawal is a barrier for initiating buprenorphine treatment in individuals with opioid use disorder (OUD), particularly among those using fentanyl. A buprenorphine “rapid micro-dosing” protocol utilizing small, escalating doses of buprenorphine can overcome this barrier, reaching therapeutic doses in three to four days. We sought to demonstrate the feasibility of implementing a buprenorphine rapid micro-dosing protocol for buprenorphine initiation in the outpatient setting.
Methods
We conducted a retrospective chart review of patients prescribed an outpatient rapid micro-dosing protocol at the Office-based Buprenorphine Induction Clinic (OBIC) from October to December 2020. The rapid micro-dosing protocol utilizes divided doses of sublingual buprenorphine tablets and blister packaging for easier dosing. Patients were not required to stop other opioid use and were advised to follow up on day four of initiation.
Results
Twelve patients were included, of whom eleven (92%) were using fentanyl at intake. Eleven patients picked up their prescription. Seven patients returned for follow up (67%), and all seven completed the rapid micro-dosing protocol. One patient reported any withdrawal symptoms, which were mild. At 30 days, seven patients (64%) were retained in care, and five (45%) were still receiving buprenorphine treatment, four of whom had been abstinent from non-prescribed opioid use for ≥2 weeks.
Conclusions
The rapid micro-dosing protocol was successful in initiating buprenorphine treatment for patients in our outpatient clinic, many of whom were using fentanyl. The rapid micro-dosing protocol may offer a safe alternative to traditional buprenorphine initiation and warrants further study.

References: De Aquino JP, Parida S, Sofuoglu M. The Pharmacology of Buprenorphine Microinduction for Opioid Use Disorder. Clin Drug Investig. 2021;41(5):425-436. doi:10.1007/s40261-021-01032-7
Klaire S, Zivanovic R, Barbic SP, Sandhu R, Mathew N, Azar P. Rapid Micro‐Induction of Buprenorphine/Naloxone for Opioid Use Disorder in an Inpatient Setting: A Case Series. Am J Addict. 2019;28(4):262-265. doi:10.1111/ajad.12869
Lee DS, Hann JE, Klaire SS, Nikoo M, Negraeff MD, Rezazadeh-Azar P. Rapid Induction of Buprenorphine/Naloxone for Chronic Pain Using a Microdosing Regimen: A Case Report. A A Pract. 2020;14(2):44-47. doi:10.1213/XAA.0000000000001138

Diversity, Equity, and Inclusion: This work shares early results of a method to increasing buprenorphine treatment uptake for individuals with opioid use disorder who face structural disadvantages to accessing treatment, particularly populations experiencing homelessness and comorbid mental health conditions. Our results can help expand buprenorphine treatment for these disadvantaged populations, reducing the disparities in treatment access.