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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial
Journal of addiction medicine, v 17(4), pp E232-E239
01 Jul 2023
PMID: 37579095
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
ObjectivesPersons with opioid use disorder (OUD) suffer disproportionately from morbidity and mortality related to serious addiction-related infections requiring hospitalization. Long-acting buprenorphine (LAB) is an underused medication for OUD that may facilitate linkage to care and treatment retention when administered before hospital discharge. Transition onto buprenorphine in the inpatient setting is often complicated by pain, active infection management, potential surgical interventions, and risk of opioid withdrawal in transition from full agonists to a partial agonist.MethodsThe COMMIT Trial is a randomized controlled trial evaluating LAB administered by infectious disease physicians and hospitalists compared with treatment as usual for persons with OUD hospitalized with infections. We report a case series of participants on full agonist opioids including methadone who were transitioned to sublingual buprenorphine using low-dose (microdosing) strategies followed by LAB injection.ResultsSeven participants with current opioid use disorder and life-threatening infections, all with significant concurrent pain and many requiring surgical intervention, underwent low-dose transitions starting at buccal buprenorphine doses ranging from 225 & mu;g to 300 & mu;g 3 times a day on the first day. All were well tolerated with average time to LAB injection of 7.5 days (range, 5-10 days).ConclusionsInpatient low-dose buprenorphine transition from full agonist opioids including methadone onto LAB is feasible even in those with complex hospitalizations for concurrent infections and/or surgery. This strategy facilitates dosing of LAB before hospital discharge when risk of opioid relapse and overdose are significant.
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Details
- Title
- Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial
- Creators
- Nikhil Seval - Drexel University, Infectious Diseases (and HIV Medicine)Johnathan Nunez - Cobham (United States)Prerana Roth - Cobham (United States)Meredith Schade - Cobham (United States)Michelle Strong - Cobham (United States)Cynthia A. Frank - Cobham (United States)Alain H. Litwin - University of South CarolinaFrances R. Levin - Cobham (United States)Kathleen T. Brady - Cobham (United States)Edward V. Nunes - Cobham (United States)Sandra A. Springer - Cobham (United States)
- Publication Details
- Journal of addiction medicine, v 17(4), pp E232-E239
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Infectious Diseases (and HIV Medicine)
- Web of Science ID
- WOS:001041146800004
- Scopus ID
- 2-s2.0-85167571534
- Other Identifier
- 991021861189704721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Substance Abuse