Transferring patients from high-dose methadone to buprenorphine: A retrospective case series

Abstract

Objective: Transferring from methadone to buprenorphine can be difficult, -particularly at higher methadone doses. Precipitated withdrawal (PW) and severe opioid withdrawal can compromise transfers and limited data guide high-dose transfers. This study describes processes and outcomes of transfers to buprenorphine from methadone.

Design: A retrospective case series of transfers from methadone to buprenorphine.

Setting: Two elective, voluntary, specialized in-patient drug and alcohol facilities in Sydney, New South Wales, Australia.

Participants: All admissions between July 1, 2015 and April 30, 2019 were screened using routinely collected coding data. The medical record was reviewed to identify subjects meeting the inclusion criteria of daily methadone use for at least 1 month, age > 18, and a treatment plan that included transfer from methadone to buprenorphine. Data were extracted on methadone dose, transfer medications, time to buprenorphine initiation, and transfer outcome.

Interventions: Subjects were transferred via two methods: morphine bridged and nonbridged.

Main outcome measure: The primary outcome measure was successful transition to buprenorphine.

Results: Seventy-one subjects met inclusion criteria, of whom 62 initiated buprenorphine and 53 discharged on buprenorphine. Longer delay to buprenorphine initiation was seen with higher methadone doses. The highest daily methadone dose in subjects completing transfer was 180 mg. Outcomes with morphine bridging, using a steady state methadone: morphine ratio of 1:4, were similar to direct transfer. Only one subject discontinued buprenorphine because of PW.

Conclusions: Transfer from high doses of methadone to buprenorphine can be achieved with high success rates in the in-patient setting.