SHM Converge Scientific Abstract ePoster Gallery-Extended-Release Morphine Bridge to Buprenorphine: A Practical Inpatient Approach to Opioid Use Disorder

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This case report describes an inpatient strategy for transitioning a patient with opioid use disorder (OUD) from full opioid agonists to buprenorphine using an extended-release morphine bridge during low-dose buprenorphine initiation (LDBI).<br /><br />The patient was a 59-year-old woman with OUD, alcohol use disorder, heart failure, alcohol-associated cirrhosis, and chronic kidney disease. She was hospitalized for severe right hip pain due to right sacroiliac septic arthritis, osteomyelitis, and pelvic abscesses. Despite drainage procedures and pain treatment, her pain remained poorly controlled.<br /><br />To improve pain control and avoid precipitated withdrawal, the team used extended-release morphine 15 mg every 12 hours plus immediate-release morphine 10–15 mg every 3 hours as needed while gradually introducing buprenorphine. The buprenorphine was started at very low doses and increased over several days:<br />- Day 2: buprenorphine 450 mcg every 12 hours<br />- Day 3: 450 mcg every 6 hours<br />- Day 4: buprenorphine-naloxone 2 mg/0.5 mg every 8 hours<br />- Day 5: 4 mg/1 mg every 8 hours<br />- Day 6: morphine was stopped except as needed, and buprenorphine-naloxone was increased to 8 mg/2 mg every 8 hours<br /><br />This approach led to significant improvement in pain and control of opioid cravings. The patient was also referred to an outpatient addiction clinic for follow-up care.<br /><br />The authors conclude that inpatient protocols using extended-release morphine as a bridge to low-dose buprenorphine initiation can improve pain management, reduce withdrawal and cravings, and support ongoing engagement in treatment for OUD.

Asset Subtitle

Helpees Guirguis

Meta Tag

Author List Aayah Fatayerji, Helpees Guirguis, Kevin Kwak, Yuri Shindo

Category Clinical Vignettes

Concept Buprenorphine Microinduction

Concept Opioid Use Disorder

Concept Buprenorphine-precipitated Opioid Withdrawal

Concept Pain Control

Concept Buprenorphine-Naloxone

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Helpees Guirguis

Track Adult

Keywords

opioid use disorder

buprenorphine initiation

low-dose buprenorphine initiation

extended-release morphine

inpatient transition

precipitated withdrawal

pain management

buprenorphine-naloxone

opioid cravings

addiction treatment

Buprenorphine Microinduction

Opioid Use Disorder

Buprenorphine-precipitated Opioid Withdrawal

Pain Control

Buprenorphine-Naloxone