Navigating Buprenorphine Therapy: A Closer Look at Microdosing vs. Macrodosing for Pain Management and Opioid Addiction - A Narrative Review.

Buprenorphine therapy is a primary treatment for opioid addiction and chronic pain, but a one-size-fits-all approach is no longer adequate. This review compares two dosing strategies: microdosing, which uses minimal doses to reduce dependence and side effects, and macrodosing, which uses higher doses that are effective but raise concerns about misuse and overdose. Tailoring therapy to individual patient needs is essential for addressing contemporary healthcare challenges in pain management and opioid addiction.

Study at a glance

Abstract

Buprenorphine therapy has emerged as a primary therapy method for both opioid addiction and chronic pain; however, the «one size fits all» approach to buprenorphine administration is no longer tenable. This review analyzes the pharmacology of both dosing approaches and their clinical outcomes, safety profiles, and societal implications, providing valuable insights for healthcare professionals. Multiple databases were used in conjunction with a set of inclusion and exclusion criteria to source articles to assess the consensus of best methods for treating opioid use disorder (OUD). This comprehensive review discusses two distinct dosing strategies, microdosing and macrodosing, through a detailed literature search to assess the differences and similarities of each strategy. Microdosing entails administering minimal buprenorphine doses, with promise in pain alleviation and addiction management while mitigating the risks of dependence and side effects typically associated with traditional opioids. In contrast, macrodosing employs higher buprenorphine doses, which is well-established for OUD and chronic pain management but raises concerns concerning misuse and overdose. Tailoring buprenorphine therapy to patients' individual needs is essential in the face of contemporary healthcare challenges related to pain management and opioid addiction.