Street Pharmacology: The Mechanistic Basis of Clinical Pharmacology Underlying the Microdosing Method of Buprenorphine–Naloxone With a Focus on the Unhoused Population
The Journal of Clinical Pharmacology June 1, 2026 David F. Lehmann, Olivia Tanner, Eliesha Pepple et al.
Expanding buprenorphine-naloxone treatment to marginalized groups, including unhoused people, is a priority but is hindered by fear of precipitating opioid withdrawal. Microdosing methods during the first week of treatment avoid requiring opioid abstinence and do not cause withdrawal. This review explains the scientific basis for microdosing, centered on the pharmacodynamic principle of pseudo-irreversibility for a partial agonist like buprenorphine.