Buprenorphine

Background

• Recommended as first-line treatment for opioid use disorder
• Typically coformulated with naloxone (trade name Suboxone) at a dose of 2 mg buprenorphine to 0.5 mg naloxone
• Buprenorphine is partial mu-opioid receptor agonist
• Theoretical ceiling effect
• Strong receptor affinity, displaces other opioids

Dosing

Full Start

• It's use can precipitate withdrawal, so wait 12-24h after short-acting opioids, 18-36h after long-acting, or after tapering methadone, before starting buprenorphine
• Day 1: Ensure they are in mild withdrawal (COWS ≥12), then give 4mg, wait a few hours, give another 4mg
• Day 2: 12mg
• Day 3: 16mg; discharge and refer to Addictions clinic

Further Reading

• Opioid Enabler
• Hämmig R et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. Subst Abuse Rehabil. 2016; 7: 99–105.