Switching From High-Dose, Long-Term Opioids to Buprenorphine: A Case Series
Authors: William C. Becker, Joseph W. Frank, Ellen L. Edens
Journal: Annals of Internal Medicine (2020)

Letters7 July 2020Switching From High-Dose, Long-Term Opioids to Buprenorphine: A Case SeriesWilliam C. Becker, MD, Joseph W. Frank, MD, MPH, and Ellen L. Edens, MD, MPEWilliam C. Becker, MDYale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut (W.C.B., E.L.E.), Joseph W. Frank, MD, MPHUniversity of Colorado School of Medicine and VA Eastern Colorado Health Care System, Aurora, Colorado (J.W.F.), and Ellen L. Edens, MD, MPEYale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut (W.C.B., E.L.E.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0725 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Sublingual buprenorphine is a well-established treatment of opioid use disorder. It is increasingly prescribed to patients receiving high-dose, long-term opioid therapy for whom the benefits of this therapy no longer outweigh the harms but who may not meet diagnostic criteria for opioid use disorder. This practice was recently endorsed by the U.S. Department of Health and Human Services (1) and subject experts (2) as an alternative when gradual dose reduction in long-term opioid therapy is unsuccessful. However, before initiation of buprenorphine therapy, guidelines recommend cessation of full agonist opioids, which induces withdrawal symptoms of at least moderate severity (3). ...References1. U.S. Department of Health and Human Services. HHS guide for clinicians on the appropriate dosage reduction or discontinuation of long-term opioid analgesics. 2019. Accessed at www.hhs.gov/opioids/sites/default/files/2019-10/Dosage_Reduction_Discontinuation.pdf on 23 December 2019. Google Scholar2. Chou R, Ballantyne J, Lembke A. Rethinking opioid dose tapering, prescription opioid dependence, and indications for buprenorphine. Ann Intern Med. 2019;171:427-9. [PMID: 31450240]. doi:10.7326/M19-1488 LinkGoogle Scholar3. Substance Abuse and Mental Health Services Administration. TIP 63 Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families. Substance Abuse and Mental Health Services Administration. 2018. Google Scholar4. Hämmig R, Kemter A, Strasser J, 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. [PMID: 27499655] doi:10.2147/SAR.S109919 CrossrefMedlineGoogle Scholar5. Ghosh SM, Klaire S, Tanguay R; et al;. A review of novel methods to support the transition from methadone and other full agonist opioids to buprenorphine/naloxone sublingual in both community and acute care settings. Can J Addict. 2019;10:41-50. doi:10.1097/CXA.0000000000000072 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut (W.C.B., E.L.E.)University of Colorado School of Medicine and VA Eastern Colorado Health Care System, Aurora, Colorado (J.W.F.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0725. 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Becker, MD and David A. Fiellin, MD 7 July 2020Volume 173, Issue 1Page: 70-71KeywordsCase seriesDrug safetyLower back painOpioid use disorderOpioidsOutpatientsSweatTherapeutic drug monitoringToxicityUrine ePublished: 7 April 2020 Issue Published: 7 July 2020 PDF downloadLoading ...