{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:18:58Z","timestamp":1791357538791,"version":"4.3.1"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,11,2]],"date-time":"2018-11-02T00:00:00Z","timestamp":1541116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Addict"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Although buprenorphine\/naloxone is widely recognized as first\u2010line therapy for opioid use disorder, the requirement for moderate withdrawal prior to initiation in efforts to avoid precipitated withdrawal can be a barrier to its initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present a case utilizing transdermal fentanyl as a bridging treatment to eliminate withdrawal during the transition from methadone to buprenorphine\/naloxone in a patient who had ongoing significant intravenous heroin use while on methadone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patient was successfully transitioned from methadone to buprenorphine\/naloxone without a period of withdrawal utilizing transdermal fentanyl as a bridge in an inpatient setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Our experience indicates a transdermal depot of fentanyl allows for slow release and elimination while buprenorphine doses are introduced during an induction without presence of withdrawal, as quantified by serial clinical opiate withdrawal score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Scientific Significance<\/jats:title><jats:p>This case report highlights ways to minimize barriers to induction of first\u2010line opioid substitution therapy, buprenorphine\/naloxone, by eliminating withdrawal during induction phase utilizing a fentanyl bridge within the limitations of a transdermal fentanyl bridge in an inpatient setting. (Am J Addict 2018;XX:1\u20134)<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajad.12809","type":"journal-article","created":{"date-parts":[[2018,11,2]],"date-time":"2018-11-02T14:19:13Z","timestamp":1541168353000},"page":"601-604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Methadone to buprenorphine\/naloxone induction without withdrawal utilizing transdermal fentanyl bridge in an inpatient setting\u2014Azar method"],"prefix":"10.1111","volume":"27","author":[{"given":"Pouya","family":"Azar","sequence":"first","affiliation":[{"name":"St Paul's Hospital Vancouver British Columbia Canada"},{"name":"Vancouver General Hospital Vancouver British Columbia Canada"},{"name":"Inner City Youth Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7692-3923","authenticated-orcid":false,"given":"Mohammadali","family":"Nikoo","sequence":"additional","affiliation":[{"name":"Addiction and Concurrent Disorders Group, Institute of Mental Health University of British Columbia Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Miles","sequence":"additional","affiliation":[{"name":"University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,2]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"British Columbia Coroners Office. Illicit Drug Overdose Deaths in BC: January 1 2007 to February 28 2017.http:\/\/www2.gov.bc.ca\/assets\/gov\/public\u2010safety\u2010and\u2010emergency\u2010services\/death\u2010investigation\/statistical\/illicit\u2010drug.pdf. Published March 17 2017. Accessed March 20 2017."},{"key":"e_1_2_5_3_1","first-page":"CD002207","article-title":"Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence","volume":"2","author":"Mattick RP","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_4_1","first-page":"CD002209","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","volume":"3","author":"Mattick RP","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_5_1","first-page":"CD004145","article-title":"Substitution treatment of injecting opioid users for prevention of HIV infection","volume":"2","author":"Gowing L","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.08.037"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13238"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2007.11.003"},{"key":"e_1_2_5_9_1","unstructured":"British Columbia Center on Substance Use. A Guideline for the Clinical Management of Opioid Use Disorder. Available online at:http:\/\/www.bccsu.ca\/wp\u2010content\/uploads\/2017\/02\/BC\u2010OUD\u2010Guidelines_FINAL.pdf. Published February 1 2017. Accessed on March 6 2017."},{"key":"e_1_2_5_10_1","unstructured":"American Society of Addiction Medicine. ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Available online at:http:\/\/www.asam.org\/docs\/default\u2010source\/practice\u2010support\/guidelines\u2010and\u2010consensus\u2010docs\/asam\u2010national\u2010practice\u2010guideline\u2010supplement.pdf. Published June 2015. Accessed on March 6 2017."},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12213"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2010.12.007"},{"key":"e_1_2_5_13_1","unstructured":"Spring B.VCH Community Palliative Care. Pain management. Clinical Practice Guidelines.2007."},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2003.10400007"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0b013e31828bfb6e"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1521-0391.2011.00159.x"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311406577"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909110373508"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2008.00461.x"}],"container-title":["The American Journal on Addictions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fajad.12809","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajad.12809","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T19:52:32Z","timestamp":1694807552000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ajad.12809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,2]]},"references-count":18,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1111\/ajad.12809"],"URL":"https:\/\/doi.org\/10.1111\/ajad.12809","archive":["Portico"],"relation":{},"ISSN":["1055-0496","1521-0391"],"issn-type":[{"value":"1055-0496","type":"print"},{"value":"1521-0391","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,2]]},"assertion":[{"value":"2018-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}