Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract:
Buprenorphine is a medication commonly used for opioid use disorder. While prescribing is limited to X-waivered providers, buprenorphine can be prescribed in an office-based treatment setting and is thought to have a more favorable safety profile than full opioid agonists. Traditional buprenorphine induction consists of allowing a patient to go into a mild to moderate withdrawal before initiating buprenorphine therapy in order to prevent precipitated withdrawal. A novel approach to buprenorphine induction, microdosing, suggests that small or micro doses of buprenorphine can be started while a patient is still on a full opioid agonist. The theory that drives this approach is that small doses of buprenorphine will slowly displace the opioid at the mu receptor binding site in a way that does not precipitate withdrawal. While there have been many suggested dosing protocols and formulations for microdosing, there is much debate as to a best method.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Discuss current practices for the treatment of opioid use disorders.
• Describe buprenorphine initiation strategies and limitations.
• Explain recent literature and protocols for buprenorphine microdosing.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Pharmacy (ACPE): This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit. The assigned universal program number(s) is JA4008223-0000-23-091-H01-P. Other Healthcare Professionals Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Suggested Additional Reading:

1. American Society of Addiction Medicine. A Patient’s Guide to Starting Buprenorphine at Home. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0
2. Antoine D, Huhn AS, Strain EC, et al. Method for Successfully Inducting Individuals Who Use Illicit Fentanyl Onto Buprenorphine/Naloxone. Am J Addict. 2021;30(1):83-87.
3. Biden moving to nix Trump plan on opioid-treatment prescriptions. Washington Post. Published 2021. https://www.washingtonpost.com/health/2021/01/25/biden-buprenorphine-waiver/
4. Buprenorphine and naloxone: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/buprenorphine-and-naloxone-drug-informationsearch=buprenorphine%20naloxone&source=panel_search_result&selectedTitle=1~19&usage_type=panel&kp_tab=drug_general&display_rank=1. 
5. Buprenorphine. SAMSHA. Published 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine

6. Buprenorphine: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/buprenorphine-drug-information?search=buprenorphine&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1. 
7. Duramed Pharmaceuticals, INC. (2013). Revia: highlights of prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/018932s017lbl.pdf
8. Ghosh SM, Klaire S, Tanguay R, et al. A Review of Novel Methods to Support the Transition from Methadone and Other Full Agonist Opioids to Buprenorphine/Naloxone Sublingual in Both Community and Acute Care Settings. Can J Addict. 2019;10(4):41-50.
9. Hämmig R, Kemter A, Strasser J, et al. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. Subst Abuse Rehabil. 2016;7:99-105. 
10. HHS Expands Access to Treatment for Opioid Use Disorder. Published 2021. https://www.hhs.gov/about/news/2021/01/14/hhs-expands-access-to-treatment-for-opioid-use-disorder.html
11. Ma J, Bao YP, Wang RJ, et al. Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol Psychiatry. 2019;24(12):1868-1883.