Table 1.

Baseline opioids, induction and post-induction among pain patients transferred to sublingual buprenorphine

ID	Baseline opioids	TDDa,b	Side effects; clinical notes	Days in trial	Total office release dose	Total Day 1 dose	Highest post induction dose
10	Codeine 90mg	15	Side effects: drowsiness, muscle twitching. Notes: Excellent pain relief but not able to tolerate the side effects even after multiple dose adjustments and additional medications. Patient requested to be withdrawn from the study.	51	2	6	6
8	Oxycodone 13.5mg	20	Side effects: pain, difficulty breathing, sweating, confusion, disorientation, dry mouth, nausea, anxiety, nervousness, increased back spasms, auditory hallucinations. Note: Went to ED after experiencing symptoms. At ED Pt. stabilized & instructed to continue w/bup w/addition of Metformin HCI. Pain not well controlled; withdrawn from bup and switched to methadone.	35	2	6	14
9	Morphine 20mg	20	Side effects: irritability, hyperactive. Notes: Initially had exceptionally good response w/excellent pain control; low profile of side effects. Effectiveness decreased after several weeks. Terminated from study.	44	2	2	8
6	Morphine 20mg; oxycodone 10mg	35	Side effects: Occasional dry mouth, blurry vision, constipation, loss of appetite and trouble sleeping. Note: Pt. completed the study (3 months). Reported adequate pain control with no major side effects. Patient started exercise regimen to increase her quality of life. Overall, patient reported good health.	>90	4	10	8
3	Oxycodone 30mg; fentanyl 12.5mcg/48hr, morphine	85	Side effects: None. Note: Although pt. initially took 2mg tid + up to 6mg bup as rescue medication, pt eventually responded well to medication and would take 2mg bid on pain free days and 2mg tid when pain was present.	>90	2	5c	12
1	Morphine 30mg	90	Side effects: chest pain, anxiety, severe perspiration, loss of appetite. Note: Stopped bup on his own; 4 days later went to ED. No abnormalities found. Terminated from study; returned to regular primary care physician for pain control.	12	2	6	10
5	Oxycodone 60mg	90	Side effects: None. Note: Pt. chose to withdraw from bup after becoming pain free. Remained pain free and did not resume opioids.	59	2	6	8
4	Oxycodone 60mg	90	Side effects: nausea, depression, weakness, drowsy, irritation. Note: Patient stopped bup on his own, experienced more severe symptoms and resumed bup 3 days later at a reduced level (6mg tid, no PRN). Patient sought counseling for depression. Despite difficult transition onto bup the patient was successfully stabilized, reported reduced pain, no subsequent adverse events and completed the study.	>90	6	18	24
7	Methadone 70mg; morphine, 105mg	211	Side effects: None. Note: Pt. called physician to report severe distress. On her own had reduced amount and frequency of bup dose for fear of adverse drug-drug interactions (had been taking a benzodiazepine). Symptoms improved after resuming bup and taking clonazepam. Continued w/study and reported effective pain control most of the time.	>90	4	8	12
2	Oxycodone 30mg; fentanyl 125mcg/48hr	303	Side effects: nausea, vomiting, sleeplessness, loss of appetite, fatigue, pain, restlessness. Note: Stopped bup & resumed fentanyl patch on his own. Terminated from study.	5	8	16	24
12	Fentanyl 225mcg/48hr	450	Side effects: Intense withdrawal symptoms & increased pain. Note: Pt. given Ativan and morphine sc, but symptoms persisted. Was transferred to ER & later admitted to hospital. Withdrawal symptoms controlled later that evening, but kept in hospital for pain control.	1	6	n/a	n/a
11	Methadone 120–200mg	~303	Side effects: anxiety, slurred speech, nausea, hallucinations, vomiting, restlessness, tingling, nervousness, hot/cold flashes, sweating, shaking uscle twitching, runny nose, teary eyes. Notes: Patient experienced pain and intense/severe withdrawal during induction period. Received morphine sc, Opana ER and Xanax to help control symptoms. Notes: Patient experience pain and intense/severe withdrawal effects during the induction period. Received morphine sc, Opana ER and Xanax to help control symptoms. Gradually, the withdrawal symptoms abated. Patient was discharged 6 hours after first induction dose and instructed to resume methadone regimen (max of 200 mg/day) he was on prior to the study.	1	8	n/a	n/a

^aTDD: Total daily dose. Subjects are sorted by TDD.

^bOral morphine conversion ratios for codeine, methadone and oxycodone were derived from Fine & Portenoy;^47,48 and for TD fentanyl from Levy (Levy’s Rule).⁴⁹ The insert in the fentanyl package has a different conversion than the one used here, and also has significant variability.⁵⁰

^cSubject had taken half of a 2mg tablet in the evening of Day 1.