Low-Dose Induction

Key Aspects and Considerations

Low-dose induction

Gradual Displacement of Full Agonist Opioids

Continued Full Agonist Opioid Use

Leverages High Affinity and Slow Dissociation

This approach allows patients to continue using full agonist opioids initially, gradually transitioning to buprenorphine as doses increase.

This approach allows patients to continue using full agonist opioids initially, gradually transitioning to buprenorphine as doses increase.

Low-dose buprenorphine initiation capitalizes on buprenorphine's high affinity for the mu-opioid receptor and its slow dissociation, which are key factors in its effectiveness.

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When to Consider

Low dose induction

Difficulty with buprenorphine induction in the past.​

Transition from full agonist opioids for pain to buprenorphine​

Intentional, daily, fentanyl consumption ​

Transitioning from methadone​

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When to Reconsider

Low dose induction

Person doesn't want to continue full agonist opioids during transition​

High risk of respiratory depression ​

Already in significant withdrawal​

Difficulties with health literacy or medication adherence​

Unable to self-administer​

Unable to dose frequently (e.g., incarcerated, work schedule) ​

Patient preference for standard induction ​

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It can delay induction​

Low-Dose Induction Strategy

3 Day

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Prescribe 2 mg buprenorphine films #6, 8 mg buprenorphine films #4 for 3-day supply​

8-16 mg (1-2 8 mg strips) SL buprenorphine once daily and 4 mg SL q6h prn withdrawal (max 32 mg total daily dose), wean or stop full opioid agonists.

Day 3

1 mg (1/2 of 2 mg strip) SL buprenorphine q3 hours (8 mg total daily dose), continue full opioid agonists.

Day 2

0.5 mg (1/4 of 2 mg strip) SL buprenorphine q3 hours (4 mg total daily dose), continue full opioid agonists. ​

Day 1

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Low-Dose Induction Strategy

7 Day

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Prescribe 2 mg buprenorphine SL strips # 15, 8 mg buprenorphine SL strips #4 for 7-day supply (administered over 8 days)​

Day 4

Day 3

Day 2

Day 8

Day 6

Day 7

Day 1

Day 5

2 mg buprenorphine SL BID (4 mg total daily dose), continue full opioid agonist.​

0.5 mg (1/4 of 2 mg strip) buprenorphine SL BID (1 mg total daily dose), continue full opioid agonist. ​

3 mg (1+1/2 of 2 mg strip) buprenorphine SL BID (6 mg total daily dose), continue full opioid agonist. ​

4 mg (2 of 2 mg strip) buprenorphine SL BID (8 mg total daily dose), continue full opioid agonist.

16 mg (2 of 8 mg strip) buprenorphine qday and 4mg (1/2 of 8 mg strip) q6h prn withdrawal (max 32 mg total daily dose), wean or stop full opioid agonists.​

0.5 mg (1/4 of 2 mg strip) buprenorphine SL daily (0.5 mg total daily dose), continue full opioid agonist. ​

1 mg (1/2 of 2 mg strip) buprenorphine SL BID (2 mg total daily dose), continue full opioid agonist. ​

6 mg (3 of 2 mg strip) buprenorphine SL BID (12 mg total daily dose), continue full opioid agonist. ​