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| Method |
Pros |
Cons |
| Micro-Dose |
- OK to keep using opioids while titrating buprenorphine |
|
- Unlikely to precipitate withdrawal
Good for:
- Recent fentanyl
- History precipitated withdrawal | - Very long transition, can be confusing to manage
- Continued opioid use prevents withdrawal symptoms: patient needs access/money
- Not appropriate if patient wants to stop opioid use immediately |
| Low Dose | - Unlikely to precipitate withdrawal Pretty good for:
- Recent fentanyl
- Recent methadone
- History precipitated withdrawal | - Long transition: pt needs to tolerate withdrawal without returning to use.
- Remember to prescribe adjunct meds to help them tolerate withdrawal symptoms. |
| Standard | - 1-day transition | - Higher risk precipitated withdrawal |
| Quick-Start | - Fastest transition (hours)
Good for:
- Recent, regular fentanyl/HPSO
- History precipitated withdrawal | - Intense withdrawal with Narcan: not recommended if pregnant or with unstable cardiac or psychiatric condition
- Less outcome data (newer) |
Micro-Dose
- Method Overview
- Transition to Treatment (Days 1-5):
- Day 6 and after:
- Follow-up Plan
Low-Dose
- Method Overview
- Premedication
- Withdrawal
- Transition to Treatment
- Day 2 and after: Normal Daily Dosing
- Follow-up Plan
Standard
- Method Overview
- Premedication
- Withdrawal
- Transition to Treatment