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Case report
Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach
  1. Mackenzie Duncan Gregory Caulfield1,
  2. Rupinder Brar2,
  3. Christy Sutherland3 and
  4. Seonaid Nolan2,4
  1. 1Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Family Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  4. 4BC Centre on Substance Use, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Seonaid Nolan; bccsu-sn{at}


In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.

  • psychiatry (drugs and medicines)
  • drug misuse (including addiction)
  • therapeutic indications
  • drugs misuse (including addiction)
  • impulse control disorders

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  • Contributors SN: conception and design, analysis of data and writing of the report. MDGC: analysis, interpretation and compilation of data and writing of report. RB: conception and design, direct contact with patient, acquisition of data, analysis and writing of report. CS: interpretation of data and revisions.

  • Funding This study was funded by (UBC Steven Diamond Professorship in Addiction Care Innovation).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.