Street Pharmacology: The Mechanistic Basis of Clinical Pharmacology Underlying the Microdosing Method of Buprenorphine–Naloxone With a Focus on the Unhoused Population

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.

Study at a glance

Abstract

Expanded use of buprenorphine-naloxone use, particularly for marginalized communities, such as the unhoused, is an established priority. Unfortunately, due to fear of the precipitation of opioid withdrawal, this goal remains unmet. In response, microdosing methods during the initial week of treatment do not require opioid abstinence and do not precipitate withdrawal. This review establishes the scientific basis for microdosing that is centered on the pharmacodynamic principle of pseudo-irreversibility for a partial agonist, such as buprenorphine.