Microdosing case study series - transferring from methadone to oral buprenorphine

Background: Transferring patients from methadone to buprenorphine is challenging and current methods may be time consuming or risk significant withdrawal symptoms. These can be a barrier to patients having access to a medication that is more appropriate for their care. "Microdosing" is an alternative method of transfer from methadone to oral buprenorphine but with limited published data. It was identified to reduce the period of instability related to a slow dose decrease of methadone dose prior to transfer and to limit the risk of significant withdrawal effects of a high dose transfer. A local guideline was produced for the transfer of patients from methadone to buprenorphine. The initial cases were then to be analysed to evaluate the use of microdosing as an alternative method of transition from methadone to oral buprenorphine. Methods: Case series of 6 patients within primary care addiction service. Results: A local guideline was produce and the results evaluated for a series of 6 patients. Four of these patients successfully completed microdose transfers. Objective and subjective withdrawal scoring was used to provide quantitative data during the process to aid the evaluation. Conclusions: The case studies demonstrate that the successful use of a microdose transition from methadone to oral buprenorphine is possible within a primary care setting with minimal side effects or discomfort and that this option could be explored further with other patients to improve therapeutic outcomes.