Abstract：
UNASSIGNED: Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described.
UNASSIGNED: We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks.
UNASSIGNED: Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.
UNASSIGNED: We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks.
UNASSIGNED: Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.
摘要：
■一些患者已确定停用舌下丁丙诺啡（SL-BUP）是阿片类药物使用障碍治疗成功的潜在结果。逐渐减少SL-BUP的过程可能很长，因为令人不快的阿片类药物戒断症状限制了剂量调整的步伐。不受控制的戒断症状会带来重新使用非法阿片类药物的风险，并且需要更多以患者为中心的选择来逐渐减少SL-BUP。以前的病例报告已经确定使用缓释皮下丁丙诺啡（ER-BUP）来最大程度地减少戒断症状，因为剂量自行逐渐减少。理想的给药策略，适当的患者特征，和丁丙诺啡与ER-BUP注射液释放的持续时间没有很好的描述。
■我们介绍了8例，其中对在SL-BUP逐渐减少期间出现无法忍受的戒断症状的患者给予单次100mgER-BUP注射。患者在注射前每天服用2至6mgSL-BUP。三名患者在接受注射后的第二天出现了轻微的不良反应，所有这些都服用较低的SL-BUP剂量（2-3mg）。在注射后的12个月里，3名患者经历轻度，但可以在不同的时间间隔内容忍戒断症状。两名患者返回服用SL-BUP，没有患者返回非法使用阿片类药物。丁丙诺啡尿毒理学显示丁丙诺啡在24周后消除。
■这些案例的研究结果支持当前基于证据的指导，即ER-BUP逐渐变细比传统的SL-BUP逐渐变细具有更好的耐受性。这些患者病例和ER-BUP的药代动力学模型表明，2至6mgSL-BUP的目标注射前剂量将使更严重的不良反应或戒断症状的风险最小化。患者和提供者应确保在开始SL-BUP锥度之前已经确定了缓解。共享的决策方法可以帮助支持患者的自主性，并了解中止SL-BUP的安全风险。未来针对更大人群的前瞻性研究可以进一步完善各种SL-BUP预注射剂量和更新的ER-BUP制剂的给药策略。
■我们介绍了8例，其中对在SL-BUP逐渐减少期间出现无法忍受的戒断症状的患者给予单次100mgER-BUP注射。患者在注射前每天服用2至6mgSL-BUP。三名患者在接受注射后的第二天出现了轻微的不良反应，所有这些都服用较低的SL-BUP剂量（2-3mg）。在注射后的12个月里，3名患者经历轻度，但可以在不同的时间间隔内容忍戒断症状。两名患者返回服用SL-BUP，没有患者返回非法使用阿片类药物。丁丙诺啡尿毒理学显示丁丙诺啡在24周后消除。
■这些案例的研究结果支持当前基于证据的指导，即ER-BUP逐渐变细比传统的SL-BUP逐渐变细具有更好的耐受性。这些患者病例和ER-BUP的药代动力学模型表明，2至6mgSL-BUP的目标注射前剂量将使更严重的不良反应或戒断症状的风险最小化。患者和提供者应确保在开始SL-BUP锥度之前已经确定了缓解。共享的决策方法可以帮助支持患者的自主性，并了解中止SL-BUP的安全风险。未来针对更大人群的前瞻性研究可以进一步完善各种SL-BUP预注射剂量和更新的ER-BUP制剂的给药策略。
