Buprenorphine microinductions: Investigating the ideal initial dose based on oral morphine equivalent requirements for stabilizing withdrawal symptoms.

OBJECTIVE: To determine if a relationship exists between oral morphine equivalent (OME) requirements to stabilize acute opioid withdrawal symptoms and the initial buprenorphine dose in patients who successfully complete a buprenorphine microinduction, defined as discharge on buprenorphine. DESIGN: Retrospective chart review. SETTING: Single-center community teaching hospital in Lancaster, Pennsylvania. PATIENTS AND PARTICIPANTS: Included adult patients admitted to Penn Medicine Lancaster General Hospital from February 1, 2022, to February 1, 2025, with opioid use disorder, who attempted a buprenorphine microinduction. A microinduction was defined as an initial sublingual buprenorphine dose less than 2 mg or a buccal dose less than 900 mcg. Patients were excluded if they were on buprenorphine prior to admission. Thirty patients met criteria for inclusion. MAIN OUTCOME MEASURE: To determine if the 24-hour OME received on the day of buprenorphine initiation (stabilizing OME) is predictive of the starting buprenorphine dose among patients who had a successful microinduction. RESULTS: Of the 30 patients, 25 (83.3 percent) successfully completed a microinduction. Among these 25 patients, there was no statistically significant association found between the initial buprenorphine dose and either the stabilizing OME or the self-reported quantity of illicit opioid use. Similarly, microinduction length was not significantly associated with either variable. CONCLUSIONS: Findings support an individualized approach to buprenorphine microinductions, as no statistically significant associations were found between the initial buprenorphine dose and stabilizing OME requirements.