Microdosing Transdermal Buprenorphine to Transition a Patient off a Higher-Dose Methadone Regimen
Hannan Moses Braun, Kristy L. Blackwood, Jeffrey P. Bratberg et al.
A patient taking high-dose methadone successfully transitioned to buprenorphine using a transdermal microdosing protocol that did not require prior methadone dose tapering and avoided opioid withdrawal symptoms. The protocol included an as-needed full opioid agonist. This case suggests that microinduction can remove the prerequisite of moderate withdrawal typically needed for buprenorphine initiation, though further research is needed to define optimal protocols, especially for patients on methadone or using illicit fentanyl.