Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series.

Claudia Epland, Haley Pals, John Hayden
{"title":"Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series.","authors":"Claudia Epland, Haley Pals, John Hayden","doi":"10.1177/29767342241242242","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nDiscontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described.\n\n\nPATIENT CASES\nWe present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks.\n\n\nDISCUSSION\nFindings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Substance use & addiction journal","FirstCategoryId":"0","ListUrlMain":"https://doi.org/10.1177/29767342241242242","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

BACKGROUND Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described. PATIENT CASES We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks. DISCUSSION Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.
丁丙诺啡减量耐受性增强评估报告 (BETTER):病例系列。
背景一些患者认为,停用舌下丁丙诺啡(SL-BUP)是阿片类药物使用障碍治疗成功的一个潜在结果。由于令人不快的阿片戒断症状限制了剂量调整的速度,因此减少 SL-BUP 的过程可能会很漫长。不受控制的戒断症状会带来再次非法使用阿片类药物的风险,因此需要更多以患者为中心的减量 SL-BUP 方案。之前的病例报告指出,使用缓释皮下丁丙诺啡(ER-BUP)可将戒断症状降至最低,因为剂量会逐渐自我减少。理想的给药策略、适当的患者特征以及使用 ER-BUP 注射剂释放丁丙诺啡的持续时间都没有得到很好的描述。患者病例我们介绍了 8 个病例,这些患者在 SL-BUP 减量过程中出现了难以忍受的戒断症状,我们为他们注射了单次 100 毫克 ER-BUP。注射前,患者每天服用 2 到 6 毫克 SL-BUP。三名患者在接受注射的第二天出现了轻微的不良反应,他们服用的 SL-BUP 剂量都较低(2-3 毫克)。在注射后的 12 个月中,3 名患者出现了轻微但可以忍受的戒断症状,间隔时间不等。两名患者重新开始服用 SL-BUP,没有患者重新开始非法使用阿片类药物。丁丙诺啡尿液毒理学检查显示,丁丙诺啡在 24 周后消失。这些患者病例和 ER-BUP 的药代动力学模型表明,2 至 6 毫克 SL-BUP 的目标注射前剂量将最大限度地降低出现更严重不良反应或戒断症状的风险。患者和医疗服务提供者在开始减少 SL-BUP 剂量之前,应确保病情已得到良好缓解。共同决策的方法有助于支持患者的自主性和理解停用 SL-BUP 的安全风险。未来针对更多人群的前瞻性研究可进一步完善各种 SL-BUP 注射前剂量和更新的 ER-BUP 配方的剂量策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信