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