Buprenorphine for planned opioid withdrawal
The same legal requirements before starting medication-assisted treatment of opioid dependence apply when prescribing buprenorphine to manage opioid withdrawal.
Because it has partial agonist effects, buprenorphine may precipitate opioid withdrawal1 in patients taking another more potent opioid. The first dose of buprenorphine should not be given until objective signs of withdrawal and subjective withdrawal symptoms are present. The dose and duration of use should be titrated according to withdrawal severity using the Clinical Opiate Withdrawal Scale, available from the National Centre for Education and Training on Addiction website. Buprenorphine can be used in either an inpatient or an outpatient setting.
A reasonable regimen for use of buprenorphine to manage planned withdrawal in an outpatient setting isCentre for Alcohol and Other Drugs, 2018NSW Health, 2008:
buprenorphine 4 to 8 mg sublingually, as a single dose on the first day, increasing to a maximum of 16 mg as a single dose on the third day. For patients wishing to stop buprenorphine, taper the dose from the fourth day over the following 2 to 5 days. For patients who wish to switch to maintenance therapy, see Overview of MATOD. buprenorphine buprenorphine buprenorphine
In an inpatient setting, the benefit of psychosocial engagement means a lower starting dose and smaller incremental dose increases may be sufficient. A reasonable regimen for use of buprenorphine to manage planned opioid withdrawal in an inpatient setting isCentre for Alcohol and Other Drugs, 2018NSW Health, 2008NSW Health, 2022:
buprenorphine 2 to 4 mg sublingually, on the first day, repeated as required every 2 hours to a maximum of 16 mg on the first day. For patients wishing to stop buprenorphine, taper the dose from the second day over the following 2 to 5 days. For patients who wish to switch to maintenance buprenorphine, see Overview of MATOD. buprenorphine buprenorphine buprenorphine
Exercise caution when prescribing buprenorphine with other sedatives, including other opioids, benzodiazepines or gabapentinoids. Observe state and territory statutory health regulations on the prescription of buprenorphine.