Case Report: High-Dose Methadone Transition to Buprenorphine/Naloxone in an Inpatient with a Prolonged QT Interval
Bibliographic record
Abstract
Methadone and some psychiatric medications are associated with QT interval prolongation. Buprenorphine/naloxone, a newer medication for opioid use disorder, has a better safety profile than methadone including less QT interval prolongation. Transitioning to buprenorphine/naloxone, however, requires patients undergo an uncomfortable period of withdrawal which may discourage treatment retention in patients with severe opioid use disorder. We describe a case of high-dose methadone transition to buprenorphine/naloxone in order to decrease QT interval length and allow optimization of psychiatric medical therapy. A protocol for transitioning high-dose methadone to buprenorphine/naloxone using slow-release transdermal buprenorphine patch and careful initiation of sublingual buprenorphine/naloxone utilizing the Clinical Opiate Withdrawal Scale for monitoring is described. La méthadone et certains médicaments psychiatriques sont associés au prolongement de l'intervalle QT. La buprénorphine / naloxone, un médicament plus récent pour le trouble de l'utilisation des opioïdes, a un meilleur profil de sécurité que la méthadone, y compris moins de prolongement de l'intervalle QT. La transition vers la buprénorphine / naloxone, cependant, nécessite que les patients subissent une période de retrait inconfortable qui peut décourager la rétention du traitement chez les patients souffrant d'un trouble sévère de l'utilisation des opioïdes. Nous décrivons un cas de transition à la dose élevée de méthadone à la buprénorphine / naloxone afin de diminuer la durée de l'intervalle QT et d'optimiser le traitement médical psychiatrique. Un protocole pour la transition de la dose élevée de méthadone à la buprénorphine / naloxone à l'aide d'un patch de buprénorphine transdermique à libération lente et une amorce soigneuse au début de la buprénorphine / naloxone sublinguale en utilisant l’échelle clinique d’élimination des opiacés pour la surveillance est décrit.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.012 | 0.010 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".