Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method

Figures & data

Table 1 Buprenorphine dosing and use of street heroin in case 1

Day	Buprenorphine (sl)	Street heroin (sniffed)
1	0.2 mg	2.5 g
2	0.2 mg	2 g
3	0.8+2 mg	0.5 g
4	2+2.5 mg	1.5 g
5	2.5+2.5 mg	0.5 g
6	2.5+4 mg	0
7	4+4 mg	0
8	4+4 mg	0
9	8+4 mg	0

Abbreviation: sl, sublingual.

Figure 1 Daily buprenorphine dose (mg), full agonist dose (in MEQDD), and SOWS scores of case 2.

Abbreviations: MEQDD, methadone equivalent daily dose; SOWS, short opioid withdrawal scale.

Table 2 Opioid doses, withdrawal symptoms, cravings, and mental state in case 2

Day	BUP (mg)	DAM (mg)	MET (mg)	Full agonist MEQDD (mg)a	SOWS score	Withdrawal symptoms (SOWS)	Cravingb	Stressc	Overallc	Relaxedc	Tensec	Remarks
1	0.2	800	600	160	0		0
2	0.4+0.4	800	40	140	1	Mild feelings of coldness	0
3	0.8+0.4	800	40	140	0		0	5	84	74	15
4	1.2+0.4	800	40	140	0		0
5	2	800	40	140	0		0
6	2.4	400	80	130	0		0	15	64	57	44
7	2.8	800	40	140	0		0
8	3	800	40	140	3	Mild feelings of coldness, mild runny eyes, mild yawning	0
9	3.4	800	40	140	1	Mild runny eyes	0	18	85	76	6
10	4	800	40	140	2	Mild feelings of coldness, mild yawning	0
11	4.8	800	80	180	3	Mild feelings of coldness, moderate yawning	0
12	6	800	60	160	0		0	5	78	76	4
13	6	800	40	140	1	Mild runny eyes	0
14	6	400	90	140	3	Mild feelings of coldness, mild yawning, mild runny eyes	0					Morning: last medication dispensing before vacation
15	6	0	180	180	7	Moderate feelings of coldness, mild runny eyes, mild aches and pain, moderate sleeping problems, mild yawning	2	35	80	81	24	Vacation
16	6	0	180	180	5	Mild feelings of coldness, mild runny eyes, mild aches and pain, moderate sleeping problems	2					Vacation
17	6	0	180	180	Missing		Missing					Vacation
18	6	0	180	180	Missing		Missing	20	73	79	26	Vacation
19	6	0	80	80	Missing		Missing					Afternoon: first medication dispensing after vacation
20	6	0	120	120	0		0
21	6	400	80	130	0		0	15	80	73	26
22	7.2	400	40	90	0		0
23	8.8	400	80	130	0		0
24	10.8	800	40	140	0		0	5	94	94	6
25	13.2	400	40	90	0		0
26	16	800	40	140	0		0
27	20	400	60	110	0		0	7	95	92	3
28	24	800	40	140	0		0
29	24	0	0	0	1	Mild yawning	0					Cessation of full agonists, diarrhea in the morning
30	24	0	0	0	0		0	8	93	84	16
31	24	0	0	0	0		0
32	24	0	0	0	0		0
33	24	0	0	0	0		0	9	85	85	15

Notes:

a Full agonist (DAM + MET) MEQDD (conversion ratio DAM:methadone 8:1).

b 0= none, 1= mild, 2= moderate, 3= severe.

c Scores from visual analogue scale (0–100).

Abbreviations: BUP, sublingual buprenorphine; DAM, oral diacetylmorphine tablets; MET, oral methadone; SOWS, short opioid withdrawal scale; MEQDD, methadone equivalent daily dose.