Search Result

The opioid crisis is a profound public health crisis, with devastating impacts on individuals, families, and communities in North America. Vancouver is one of the most affected regions in Canada. To combat the rising opioid overdose epidemic, opioid agonist treatment and harm reduction services have become more readily accessible, and patient centered. The most effective approach to decreasing the morbidity and mortality of people with opioid use disorder is opioid agonist treatment. Initiation of opioid agonist treatment, including buprenorphine and methadone, is a complex and crucial step in care for those beginning pharmacological treatment, as well as those transitioning between medications, as poor treatment retention is largely attributed to discomfort during the induction period due to precipitated withdrawal symptoms. A variety of techniques and protocols have been developed to combat treatment barriers, including rapid micro-induction using sublingual buprenorphine-naloxone; this method eliminates the need for an abstinence period prior to administration of the first dose of buprenorphine/naloxone, and lowers the risk of precipitated withdrawal symptoms. We conducted a case series, involving two patients, that demonstrates the efficacy and safety of a novel induction technique using transdermal buprenorphine (Butrans)®, to extended-release buprenorphine subcutaneous injection (Sublocade®) for the treatment of opioid use disorder, done over a 48-hour period. Both patients experienced minimal withdrawal symptoms throughout induction and no adverse effects. This technique, also called the IPPAS method, has similar advantages to that of rapid micro-induction, in addition to reduced nurse workload, steadier blood level concentrations of buprenorphine, and increased accuracy of dose administration. In addition, this technique is more outpatient friendly with less reliance on patients to time their own doses. There is a need for further research among larger patient populations to assess the safety and efficacy of this induction method using transdermal buprenorphine in different settings and patient demographics, including youth with OUD.