Researchers from the University of Colorado School of Medicine released a case report of 3 individuals who successfully transitioned from low dose buprenorphine to a single extended-release treatment. The report was published in the Journal of Addiction Medicine.
A male aged 51 years who had opioid and alcohol use disorders had achieved remission from his opioid use disorder (OUD) for 6 years and used 8 mg sublingual buprenorphine (SL-BUP) daily. The patient had attempted to taper his SL-BUP, however when the dose was below 2 mg, he experienced adverse reactions including headache, insomnia, leg pain, and irritability. Attempts to use tramadol or transdermal buprenorphine patches with clonidine and lorazepam failed.
After remaining on 4 mg of SL-BUP daily, the patient was given a single 100 mg subcutaneous injection of extended-release buprenorphine (XR-BUP). After 2 weeks he reported similar symptoms that he had felt prior to taking 4 mg SL-BUP daily, but with an improvement of his constipation symptoms and episodes of depersonalization. No relapse or new withdrawal symptoms were experienced.
A female aged 35 years in sustained remission for her alcohol use disorder had relapsed and became dependent on oxycodone during her third trimester of pregnancy. At delivery she had been using 30 mg of oxycodone daily. After maintaining a 6 mg daily dose of SL-BUP for 14 months, she was able to taper down to 2 mg of SL-BUP.
At the tapered dosage, however, she reported headaches and nausea and struggled to care for her 1-year old child. She was given an XR-BUP injection after which she reported no withdrawal symptoms and remained opioid free.
A female aged 46 was dependent on opioids for 8 years following multiple surgeries. She was able to transition to 12 mg SL-BUP for 12 months. After a mastectomy she returned using full agonist opioids post-operation. Following a 2-year taper, she returned to a 20 mg daily dose of SL-BUP which she was able to taper down to 6 mg.
After the XR-BUP injection, the patient reported no withdrawal symptoms beyond nausea immediately following the injection. The patient experienced 3 bouts of pain during the 11 months after the XR-BUP treatment requiring opioid medications but was able to successfully discontinue use after a 1- to 4-week period.
A limitation of this case report was that it remains unclear whether XR-BUP may be appropriate for a general population of individuals with OUD as only 1 of the patients in this case report met the criteria for OUD.
Although further studies of XR-BUP are needed, these observations indicated that a single, extended release BUP injection may allow for individuals with dependence on opioids to discontinue their SL-BUP use with little risk for adverse withdrawal symptoms or relapse.
Ritvo A D, Calcaterra S L, and Ritvo J I. Using extended release buprenorphine injection to discontinue sublingual buprenorphine: a case series [published online September 10, 2020]. J Addict Med. doi: 10.1097/ADM.0000000000000738