Initiation of Low-Dose Intravenous Buprenorphine for Opioid Use Disorder: A Case Series and Literature Review

Opioid use disorder (OUD) remains a significant public health challenge with patients often facing barriers to initiating medications for opioid use disorder (MOUD). Traditional initiation methods for buprenorphinenaloxone (buprenorphine/naloxone) can be challenging due to the longer duration of transition and the risk of precipitated withdrawal. This manuscript presents a case series of four patients who successfully transitioned to buprenorphine/naloxone maintenance using a novel approach: low-dose intravenous (IV) buprenorphine initiation. These cases presented in the manuscript involved patients with dual diagnoses of OUD and difficult-to-treat pain. Intravenous buprenorphine was administered at a dose of 0.3 mg every halfhour, with a maximum of four doses. Patients' withdrawal symptoms were monitored using the Clinical Opioid Withdrawal Scale (COWS). Comfort medications were provided as needed. All four patients were successfully transitioned to sublingual (SL) buprenorphine/naloxone without experiencing precipitated withdrawal. Patients were discharged with follow-up appointments at buprenorphine/naloxone clinics and bridge supplies of buprenorphine/naloxone. Low-dose IV buprenorphine initiation offers a rapid and effective method for transitioning patients from full-agonist opioids (FAOs) to buprenorphine/naloxone without precipitated withdrawal. This approach has the potential to increase treatment retention and patient satisfaction. This case series highlights the success of low-dose IV buprenorphine initiation in patients with OUD and chronic pain. Further research is needed to standardize this approach and assess long-term outcomes. Initiating MOUD with this method may improve patient care and reduce the burden on the healthcare system.