Maintaining Evidence-based Opioid Agonist Treatment During a Methadone to Buprenorphine Rotation With Slow-release Oral Morphine
Bibliographic record
Abstract
ABSTRACT Patients may transition from methadone to buprenorphine-naloxone for various reasons. Alternative methods to ease this transition have been reported in the literature including low-dose buprenorphine (microdosing) and using slow-release oral morphine (SROM). We present the case of a 34-year-old male presenting to the hospital with stimulant-induced psychosis, wishing to transition from methadone to buprenorphine. Given the long and variable half-life of methadone, a wash-out period of at least 5 days is recommended to avoid precipitated withdrawal, before starting buprenorphine-naloxone. This can be a high-risk period if a patient decided to leave against medical advice during the transition. To reduce withdrawal symptoms during this period and to maintain the patient on opioid agonist treatment, SROM was started the day after methadone was discontinued. SROM and immediate-release morphine PRN were increased every 1–2 days (maximum dose of 570 mg daily) and on day 6, a rapid induction of buprenorphine-naloxone was initiated. In 3 days, he stabilized on 32 mg and continued on this dose for the remainder of his hospitalization. He later transitioned to buprenorphine extended-release injection. This case highlights an approach to facilitate transitioning from methadone to buprenorphine-naloxone and subsequently buprenorphine extended-release injection that prioritizes patient comfort and treatment retention, maintaining the use of evidence-based opioid agonist therapy throughout treatment. Les patients peuvent passer de la méthadone à la buprénorphine-naloxone pour diverses raisons. Des méthodes alternatives pour faciliter cette transition ont été rapportées dans la littérature, notamment la buprénorphine à faible dose (“microdosage”) et l’utilisation de la morphine orale à libération prolongée (LP). Nous présentons le cas d’un homme de 34 ans se présentant à l’hôpital avec une psychose induite par des stimulants, souhaitant passer de la méthadone à la buprénorphine. Étant donné la demi-vie longue et variable de la méthadone, une période d'élimination d’au moins 5 jours est recommandée pour éviter un sevrage précipité, avant de commencer la buprénorphine-naloxone. Cette période peut être à haut risque dans le cas où un patient déciderait de partir contre avis médical pendant la transition. Afin de réduire les symptômes de sevrage pendant cette période et de maintenir le patient sous traitement par agoniste opioïde (TAO), le LP a été commencé le jour suivant l’arrêt de la méthadone. Le LP et la morphine à libération immédiate (LI) ont été augmentées tous les 1 à 2 jours (dose maximale de 570 mg par jour) et le 6e jour, une induction rapide de buprénorphine-naloxone a été initiée. En trois jours, il s’est stabilisé à 32 mg, et a continué à prendre cette dose pendant le reste de son hospitalisation. Il est ensuite passé à la buprénorphine injectable à libération prolongée. Ce cas met en évidence une approche visant à faciliter la transition de la méthadone à la buprénorphine-naloxone, puis à la buprénorphine à libération prolongée par injection, qui donne la priorité au confort du patient et à la rétention du traitement, tout en maintenant l’utilisation d’un traitement par agoniste opioïde fondé sur des preuves tout au long du traitement.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".