Table 2.

Injectable opioid agonist therapy (iOAT) to buprenorphine/naloxone transition protocol using a micro-induction approach

Date	Intravenous hydromorphone (HM) (mg/route/frequency)	Slow-release oral morphine (SROM) (mg/route/frequency)	Buprenorphine/ naloxone (mg/route/frequency)	Notes
Day 1	170 mg intravenous or intramuscular two times per day	500 mg PO dwi	0.5 mg SL QD
Day 2	Missed dose	Missed dose	0.5 mg SL QD
Day 3	Missed dose	Missed dose	1 mg SL QD
Day 4	170 mg intravenous or intramuscular two times per day	300 mg PO dwi	1 mg SL QD	COWs score 7.
Day 5	170 mg intravenous or intramuscular two times per day	300 mg PO dwi	1.5 mg SL QD	Denied illicit use during days of missed doses.
Day 6	170 mg intravenous or intramuscular two times per day	300 mg PO dwi	1.5 mg SL QD	Missed HM and SROM ×4. Wants to go onto buprenorphine/naloxone more quickly. Reports mild withdrawal (night sweats and chills).
Day 7	Missed dose	Missed dose	2 mg SL QD
Day 8	Missed dose	Missed dose	2 mg SL QD
Day 9	Missed dose	Missed dose	3 mg SL QD
Day 10	Missed dose	Missed dose	3 mg SL QD
Day 11	Missed dose	Missed dose	Missed dose
Day 12	Missed dose	Missed dose	4 mg SL QD	States that he wants to continue with microdosing.
Day 13	170 mg intravenous or intramuscular two times per day	300 mg PO dwi	4 mg SL QD	Frustrated with microdosing and how long it is taking.
Day 14	Missed dose	Missed dose	Missed dose	Precipitated withdrawal after taking higher than recommended dose (against medical advice).
Day 20	Discontinued	Discontinued	16 mg SL QD	Was using street heroin.
				Insomnia ×5 days. Reports mild withdrawal.
Day 24	Discontinued	Discontinued	16 mg SL QD	Reports mild withdrawal over weekend.

COWs, Clinical Opiate Withdrawal Scale; dwi, daily witnessed ingestion; PO, oral route of administration; QD, once daily dosing; SL, sublingual route of administration.