TABLE 8.
Case reports data synthesis
| BUP initiation strategy | Number of patients, n (%) | Age, range (mean) | Male, n (%) | Inpatient setting, n (%) | Previous heroin use, n (%) | OME prior to initiation, range (mean, median) | BUP starting dose, mg/day, range (mean, SD) | BUP ending dose (mg/day), range (mean, SD) | Duration of full opioid agonist overlap in days, range (mean) | Duration of initiation in days, range (mean, median) | Highest COWS/SOWS score reported during initiation | Experienced withdrawal, n (%) | Successful initiation, n (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OUD Indication (n = 45) | |||||||||||||
| Traditional initiation | 6 (13.3) | 28–55 (40) | 6 (100) | 0 (0) | 5 (83.3) | Unable to calculate | 2–24 (18, 9.63) | 8–16 (14.7, 3.27) | NA | 1–3 (2.3) | 16 (COWS) a | 5 (83.3) a | 6 (100) |
| Microdosing with SL BUP | 28 (62.3) | 19–67 (40.7) | 17 (60.7) | 5 (17.9) | 14 (50) a | 80–250,000 (18406, 550) a | 0.2–2 (0.7,0.64) a | 8–32 (16.7, 7.89) a | 2–28 (7.9) a | 2‐ >250 (21.8, 8) a | 9 (COWS), 11 (SOWS) a | 6 (21.4) a | 27 (96.4) |
| Microdosing with BUP patch | 10 (22.2) | 21–65 (43.4) | 8 (80) | 8 (80) | 7 (70) a | 30–1680 (359.6, 106.5) a | 5–35 μg/h patch (16.5, 5.79) | 7–24 (12.6, 5.25) | 1–10 (2.7) | 2–12 (4.9) | 16 a | 6 (60) a | 10 (100) |
| Microdosing with IV BUP | 1 (2.2) | 62 | 1 (100) | 1 (100) | 1 (100) | 500 | 0.1 b | 10 | 4 | 6 | 10 | 1 (100) | 1 (100) |
| Pain indication (n = 29) | |||||||||||||
| Microdosing with SL BUP | 20 (69) | 11–76 (53.8) | 11 (55) | 6 (30) | NA | 65–2500 (375.6, 155) | 0.5–2 (0.67, 0.46) a | 0–18 (9.6, 5.72) | 2–18 (6.9) a | 3–19 (7.4) a | 12 a | 2 (0.1) a | 20 (100) |
| Microdosing with BUP patch | 8 (27.6) | 38–72 (55.3) | 6 (75) | 3 (37.5) | NA | 32–320 (118.3, 60) a | 10–20 μg/h patch (16.25, 5.18) | 0.75–32 (13.9, 12.23) | 0–4 (1.8) a | 4–6 (4.7) a | 3 a | 0 (0) a | 8 (100) |
| Microdosing with BUP buccal film | 1 (3.4) | 59 | 0 (0) | 1 (100) | NA | 750–1282 | 225 μg film | 16 | 6 | 7 | 3 | 0 (0) | 1 (100) |
| OUD and pain indication (n = 19) | |||||||||||||
| Traditional initiation | 1 (5.3) | 38 | 0 (0) | 1 (100) | 1 (100) | 800 | 26 | 26 | NA | 1 | 17 | 1 (100) | 1 (100) |
| Microdosing with SL BUP | 9 (47.4) | 29–63 (40.3) | 1 (11.1) a | 9 (100) | 7 (77.8) a | 86–1230 (369.3, 120) a | 0.25–8 (1.8, 2.44) | 10–24 (15.7, 4.18) | 1–16 (6.6) | 3–16 (7.6) | 2 a | 0 (0) | 9 (100) |
| Microdosing with BUP patch | 7 (36.8) | 21–67 (48) | 4 (57.1) | 6 (85.7) | 4 (57.1) a | 75–640 (262.4, 230) | 10–20 μg/h patch (18.6, 3.78) | 4–16 (11.4, 4.28) | 3–6 (3.6) | 4–7 (4.9) | 5 a | 2 (28.6) a | 7 (100) |
| Microdosing with IV BUP | 2 (10.5) | 60–65 (62.5) | 0 (0) | 2 (100) | NR | 320 a | 0.6 b | 16–28 (22, 8.49) | 3–4 (3.5) | 3–4 (3.5) | NR | 0 (0) a | 2 (100) |
Abbreviations: BUP, buprenorphine; IV, intravenous; NR, not reported; OME, oral morphine equivalents; OUD, opioid use disorder; SL, sublingual; TD, transdermal.
a
Not reported in some cases.
b
IV dose.