The article, “Low Dose Buprenorphine Initiation: A Guide for the Inpatient Clinician,” has been published in SAj.
In this commentary, the authors state that no literature exists directly comparing traditional buprenorphine initiation to low dose buprenorphine initiation (LDBI). Until information on long-term outcomes is available, these dosing strategies should be reserved for patients unable to tolerate traditional buprenorphine initiation. Available published research suggests LDBI strategies will allow some patients to successfully transition to buprenorphine with minimal or no symptoms of withdrawal. Ensuring access to pharmacotherapy during hospital admission is a crucial time for potential intervention and should be considered when appropriate. This narrative review discusses the background of LDBI strategies as well as practical clinical and operational considerations for the inpatient clinician.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“While vast, evidence surrounding LDBI is limited to case series, feasibility studies, single-arm retrospective cohort studies, and comparative studies using historical controls. There are no prospective, randomized studies directly comparing clinical outcomes of varying buprenorphine dosing strategies.”
“Due to lack of high-quality evidence supporting LDBI, these strategies should be reserved for patients who cannot tolerate traditional buprenorphine initiation and would otherwise be precluded from receiving buprenorphine. Patients with concomitant pain, high distress, medically fragile, or those with concurrent illicit fentanyl use may prove the best candidates for these strategies.”