The official journal of
EUROPAD - European Opiate Addiction Treatment Association
WFTOD - World Federation for the Treatment of Opioid Dependence
Editor: Icro Maremmani, MD - Pisa, Italy, EU
Associate Editors:
Thomas Clausen, MD - Oslo, Norway
Pier Paolo Pani, MD - Cagliari, Italy, EU
Marta Torrens, MD - Barcelona, Spain, EU
Statistical Editor:
Mario Miccoli, PhD - Pisa, Italy, EU

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Heroin Addiction and Related Clinical Problems: 2024, 26, 3

Micro-dosing with buprenorphine when switching from full agonists (methadone, SR-morphine) to buprenorphine treatment in opioid agonist-assisted treatment programmes in Slovenia

Miha Lavre, and Andrej Kastelic

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Summary: Background. Buprenorphine is, besides methadone (in Slovenia, SR-morphine, as well), the most prescribed medication for the treatment of opioid use disorder. As it is a µ-opioid receptor partial agonist, patients should traditionally experience withdrawal before starting buprenorphine treatment to prevent precipitated withdrawal in people who use full opioid agonists. Methods. Micro-dosing refers to the administration of slowly increasing buprenorphine dosage to manage opioid withdrawal symptoms while switching from full opioid agonist to partial agonist, starting with very low doses of buprenorphine and increasing them until optimal stabilization and control of withdrawal symptoms is achieved. Results. Our experience is increasing doses of buprenorphine over 5 to 7 or even more days until a full maintenance dose of buprenorphine and stopping the full agonist dose when stabilization has been achieved. Conclusions. This method might be used in the transition from methadone or sr-morphine to buprenorphine and even from heavy use of i.v. or intra-nasal fentanyl.

Keywords: opioid agonist treatment; buprenorphine induction; transition from full to partial agonist; micro-dosing; long-acting buprenorphine depot


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