Switch from methadone to buprenorphine with microinduction in outpatient setting.

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL Tidsskrift for Den Norske Laegeforening Pub Date : 2024-09-05 Print Date: 2024-09-10 DOI:10.4045/tidsskr.24.0073

Farid Juya, John Fredrik Askjer, Linda Merete Kaaberg Dahl, Line Holtan, Jon Mordal

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Abstract

Background: Switching from methadone to buprenorphine in patients receiving opioid maintenance therapy often requires inpatient care with a gradual tapering of methadone and an opioid-free day with challenging withdrawal symptoms. This case report describes and discusses a gentle outpatient approach without the opioid-free day.

Case presentation: A patient with a 15-year history of opioid maintenance therapy reduced his methadone dose from 80 mg to 50 mg due to concurrent use of other sedative substances and a significant risk of overdose. A week-long switch to buprenorphine 16 mg subcutaneous depot formulation was then undertaken using a microinduction approach in the outpatient setting.

Interpretation: In line with earlier reports on microinduction, the switch from methadone to buprenorphine was carried out with no opioid withdrawal symptoms or complications. Microinduction offers a smooth and more patient-friendly approach to switching from full opioid agonists to partial agonists. Randomised controlled trials are, however, needed for a systematic evaluation of this method.

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在门诊环境中用微量导入法将美沙酮转换为丁丙诺啡。

背景：接受阿片类药物维持治疗的患者从美沙酮转为丁丙诺啡时，通常需要住院治疗，逐渐减少美沙酮用量，并在无阿片类药物日期间出现具有挑战性的戒断症状。本病例报告描述并讨论了一种温和的门诊治疗方法，该方法不需要 "无阿片日"：一位有 15 年阿片类药物维持治疗史的患者，由于同时使用其他镇静药物和过量用药的巨大风险，将美沙酮剂量从 80 毫克减至 50 毫克。随后，他在门诊环境中采用微诱导方法，转用丁丙诺啡 16 毫克皮下去势制剂，为期一周：与之前关于微诱导的报道一致，从美沙酮到丁丙诺啡的转换过程中没有出现阿片类药物戒断症状或并发症。微诱导为从完全阿片类受体激动剂向部分受体激动剂的转换提供了一种平稳且对患者更友好的方法。不过，要对这种方法进行系统评估，还需要进行随机对照试验。

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