{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:32:20Z","timestamp":1777883540283,"version":"3.51.4"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T00:00:00Z","timestamp":1712620800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp;amp; Addiction Journal"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Cases:<\/jats:title>\n                    <jats:p>We present 8 cases where a single 100\u2009mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6\u2009mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3\u2009mg). In the 12\u2009months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24\u2009weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6\u2009mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342241242242","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T05:01:32Z","timestamp":1712638892000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series"],"prefix":"10.1177","author":[{"given":"Claudia","family":"Epland","sequence":"first","affiliation":[{"name":"Minneapolis Veterans Affairs Hospital, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-5251","authenticated-orcid":false,"given":"Haley","family":"Pals","sequence":"additional","affiliation":[{"name":"Tomah Veterans Affairs Medical Center, Tomah, WI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hayden","sequence":"additional","affiliation":[{"name":"Independent Scholar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,4,9]]},"reference":[{"key":"bibr1-29767342241242242","doi-asserted-by":"publisher","DOI":"10.2147\/PROM.S297699"},{"key":"bibr2-29767342241242242","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108804"},{"key":"bibr3-29767342241242242","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000738"},{"issue":"9","key":"bibr4-29767342241242242","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1111\/add.15818","volume":"117","author":"Torres-Lockhart KE","year":"2022","journal-title":"Addiction"},{"issue":"12","key":"bibr5-29767342241242242","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1001\/jamapsychiatry.2013.2216","volume":"70","author":"Sigmon SC","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"bibr6-29767342241242242","first-page":"1","volume":"14","author":"The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update","year":"2020","journal-title":"J Addict Med"},{"issue":"3","key":"bibr7-29767342241242242","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/ajad.13414","volume":"32","author":"Rodriguez C","year":"2023","journal-title":"Am J Addict"},{"key":"bibr8-29767342241242242","unstructured":"US Food and Drug Administration. Drug Approval Package: SUBLOCADE (buprenorphine). Clinical pharmacology and biopharmaceutics review. Application number 209819. 2017. Accessed January 24, 2022. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/2017\/209819Orig1s000TOC.cfm"},{"issue":"3","key":"bibr9-29767342241242242","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1161\/CIRCOUTCOMES.111.964791","volume":"5","author":"Hess EP","year":"2012","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"6","key":"bibr10-29767342241242242","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1164\/rccm.200906-0907OC","volume":"181","author":"Wilson SR","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"issue":"6","key":"bibr11-29767342241242242","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1097\/ADM.0000000000000789","volume":"15","author":"Zweben JE","year":"2021","journal-title":"J Addict Med"}],"container-title":["Substance Use &amp;amp; Addiction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29767342241242242","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/29767342241242242","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29767342241242242","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T01:49:38Z","timestamp":1777600178000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/29767342241242242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,9]]},"references-count":11,"alternative-id":["10.1177\/29767342241242242"],"URL":"https:\/\/doi.org\/10.1177\/29767342241242242","relation":{},"ISSN":["2976-7342","2976-7350"],"issn-type":[{"value":"2976-7342","type":"print"},{"value":"2976-7350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,9]]},"article-number":"29767342241242242"}}