Inpatient Transition from Methadone to Buprenorphine–Naloxone Using a Microdosing Strategy in a Postoperative Cancer Patient: A Case Report

A postoperative cancer patient who was taking buprenorphine–naloxone for chronic noncancer pain and then switched to methadone for uncontrolled cancer-related pain successfully transitioned back to buprenorphine–naloxone using a microdosing strategy over one week in an inpatient setting. This approach avoided the need to reduce total opioid intake before starting buprenorphine, which is typically required to prevent precipitated withdrawal. The case suggests that microdosing may be a feasible method for transitioning from methadone to buprenorphine in patients who require higher opioid doses, such as those with cancer pain, though more research on its tolerability is needed.

Study at a glance

Abstract

Background: Buprenorphine initiation in opioid-tolerant patients usually requires decreasing the total opioid intake per day due to its potential for precipitating withdrawal. However, this strategy may not be tolerated in patients who require higher amounts of opioids, such as those with cancer pain. Case Presentation: We utilized a buprenorphine microdosing strategy for a postoperative cancer patient who was previously taking buprenorphine–naloxone for chronic noncancer pain, then initiated on methadone for uncontrolled cancer-related pain. He had a planned cancer resection in the hospital. He subsequently underwent a successful transition from methadone to buprenorphine–naloxone through microdosing in one week with close monitoring in the inpatient setting. Conclusions: Using a microdosing strategy to transition from methadone to buprenorphine–naloxone in a span of days was achieved in this case report. More research regarding the feasibility and tolerability of microinductions is needed, especially in the setting of chronic pain or cancer-related pain.