Yale University’s 2021 Annual Meeting Fellow Lightning Round Presentation
During the June 2021 Annual Meeting’s Fellows Lightning Round session, Shawn Cohen, MD, presented “Simplifying Buprenorphine Microinduction in the Outpatient Setting.” Dr. Cohen is a second-year fellow in the Yale Program in Addiction Medicine.
Dr. Cohen’s presentation defined microinduction, described how his team explains it to partners and patients, and provided a few resources that may be used to aid its explanation. These resources include a Tweetorial that can be found in the presentation slides.
In his presentation, there is a car analogy that he explains as follows: Full opioid agonism is like a car speeding at 120 mph. Buprenorphine, a partial agonist, represents a car going 60 mph.
In low dose initiation, the full opioid agonist is continued, and buprenorphine is started at a low dose (usually 0.5 mg). The buprenorphine is increased by a small amount each day leading to only small amounts of the full agonist being displaced at mu opioid receptors, which means the car gradually slows until it reaches 60 mph. This gradual slowing avoids the sensation of abruptly stopping (precipitated withdrawal).