Discussion
These cases highlight the benefits of micro-dose induction versus
conventional induction: it can make buprenorphine-naloxone more enticing
for patients who do not want to withdraw from opioids, reduces hospital
utilization because it is done outpatient, and preserves the benefits of
conventional induction. Furthermore, in patients with SCD on chronic
opioids, where a conventional induction could trigger a sickle cell pain
episode due to the biologic and emotional stress of opioid withdrawal,
micro-induction may have added benefits.
Limitations of this case series is that only two individuals were
included, both of whom have Hemoglobin SC disease, and not the more
common and typically more severe Hemoglobin SS disease. However,
effectiveness and safety should not differ substantially between the two
genotypes. More research is needed on important outcomes, such as pain
management, healthcare utilization, quality of life, and
cost-effectiveness.
CONFLICT OF INTEREST STATEMENT
The authors declare no potential conflict of interest.
AUTHOR CONTRIBUTIONS
BB, TJ, and TEW contributed to clinical care and primary manuscript
composition. HT contributed to clinical care and made critical edits.
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Table 1. Buprenorphine-naloxone outpatient micro-dosing protocol – Case
1
Table 2. Buprenorphine-naloxone outpatient micro-dosing protocol – Case
2