Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting - a case series

Am J Drug Alcohol Abuse. 2021 Sep 3;47(5):599-604. doi: 10.1080/00952990.2021.1963757. Epub 2021 Aug 18.

Abstract

Background: Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described.

Objectives: To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated.

Methods: Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours.

Results: Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients.

Conclusions: Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.

Keywords: Opioids; buprenorphine; depot; methadone; opioid use disorders; transition.

MeSH terms

  • Administration, Sublingual
  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / therapeutic use
  • Buprenorphine / administration & dosage*
  • Buprenorphine / therapeutic use
  • Delayed-Action Preparations
  • Germany / epidemiology
  • Humans
  • Injections, Subcutaneous
  • Male
  • Methadone / therapeutic use
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / drug therapy*
  • Prisons
  • Retrospective Studies

Substances

  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Buprenorphine
  • Methadone