Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e88-e90
DOI: 10.1055/a-2250-6419
Case Report

Buprenorphine Induction Using Microdosing for the Management of Opioid Use Disorder in Pregnancy

Neil B. Patel 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
,
Barbara V. Parilla
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Conventional buprenorphine inductions require patients to abstain from full agonist opioids until they experience mild-to-moderate opioid withdrawal. We described a successful buprenorphine induction case in a pregnant patient using microdosing, which avoided withdrawal symptoms.

Case Presentation The patient is a 29-year-old G2P1001 at 18 2/7 weeks of gestation, who desired a switch from methadone to buprenorphine to minimize neonatal opioid withdrawal syndrome (NOWS), which complicated her last pregnancy. She was given increasing microdoses of buprenorphine over a 7-day period, while continuing her daily dose of methadone. She discontinued the methadone on day 8. She did well during the week of buprenorphine microdosing, with no complaints of withdrawal or cravings. She was engaged in her prenatal care. Her dose of buprenorphine was increased to 8 mg twice daily in the third trimester for some withdrawal symptoms in the evening consisting of new onset nausea and vomiting.

The patient underwent an elective 39-week induction of labor and had a spontaneous vaginal delivery of an appropriately grown male fetus. Only nonpharmacologic interventions were used.

Conclusion Buprenorphine microdosing was well tolerated in this patient and avoided withdrawal symptoms in the mothers, and NOWS. A microdosing study in pregnancy is indicated

Keywords

opioid use disorder pregnancy - buprenorphine pregnancy - buprenorphine microdosing pregnancy - microdosing buprenorphine


Publication History

Received: 15 February 2023

Accepted: 19 October 2023

Accepted Manuscript online:
22 January 2024

Article published online:
18 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A novel approach to assessing infants with neonatal abstinence syndrome. Hosp Pediatr 2018; 8 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 2 Choo RE, Huestis MA, Schroeder JR, Shin AS, Jones HE. Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend 2004; 75 (03) 253-260
    CrossrefPubMedGoogle Scholar
  • 3 Terasaki D, Smith C, Calcaterra SL. Transitioning hospitalized patients with opioid use disorder from methadone to buprenorphine without a period of opioid abstinence using a microdosing protocol. Pharmacotherapy 2019; 39 (10) 1023-1029
    CrossrefPubMedGoogle Scholar
  • 4 Accessed November 17, 2021 at: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
    PubMed
  • 5 Randhawa PA, Brar R, Nolan S. Buprenorphine-naloxone “microdosing”: an alternative induction approach for the treatment of opioid use disorder in the wake of North America's increasingly potent illicit drug market. CMAJ 2020; 192 (03) E73
    CrossrefPubMedGoogle Scholar
  • 6 Medications for Opioid Use Disorder. Treatment Improvement Protocol. Tip 63. Updated 2021. SAMHSA. Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed January 26, 2023 at: https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-02-01-002.pdf
    PubMed
  • 7 Hämmig R, Kemter A, Strasser J. et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. Subst Abuse Rehabil 2016; 7: 99-105
    CrossrefPubMedGoogle Scholar
  • 8 Robbins JL, Englander H, Gregg J. Buprenorphine microdose induction for the management of prescription opioid dependence. J Am Board Fam Med 2021; 34 (Suppl): S141-S146
    CrossrefPubMedGoogle Scholar
  • 9 Opioid use and opioid use disorder in pregnancy. Committee opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017; 130: e81-e94
    CrossrefPubMedGoogle Scholar
  • 10 Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M. Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database Syst Rev 2013; (12) CD006318
    PubMedGoogle Scholar
  • 11 Anderson C, Cooley R, Patil D. Transitioning from high-dose methadone to buprenorphine using a microdosing approach: unique considerations at ASAM level 3 facilities. J Addict Med 2022; 00: 1-4
    PubMedGoogle Scholar