Using Extended Release Buprenorphine Injection to Discontinue Sublingual Buprenorphine: A Case Series
Alexis Ritvo, Susan L. Calcaterra, Jonathan I. Ritvo
Abstract
Buprenorphine is highly effective for the treatment of opioid use disorder and is increasingly being used in the treatment of chronic pain. For various reasons, patients on buprenorphine may request discontinuation of this medication. Tapering off buprenorphine can be challenging due to intolerable withdrawal symptoms, including nausea, malaise, anxiety, and dysphoria. A single dose of extended-release buprenorphine may facilitate discontinuation of buprenorphine by mitigating prolonged, debilitating opioid withdrawal symptoms. We report on three cases of successful transition from low dose sublingual buprenorphine to a single injection of 100 mg extended-release buprenorphine to opioid cessation in patients who had previously been unable to taper fully off buprenorphine. This novel use of extended-release buprenorphine provides a viable alternative to fully transition patients off buprenorphine when they are medically and emotionally ready.