{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T19:05:18Z","timestamp":1789239918819,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Addict Sci Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Buprenorphine (Bup) is a first-line medication for opioid use disorder (OUD) that carries risk of precipitated withdrawal (PW) with ongoing need for rapid and effective initiation strategies. We report a novel approach to low-dose initiation using transdermal Bup patches (TD-Bup) and characterize the efficacy and tolerability of 24\u2009h and 48\u2009h TD-Bup initiation protocols for Bup as a medication for OUD (MOUD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective chart review using data extracted from paper and electronic medical records of adult inpatients with OUD admitted to Vancouver General Hospital between January 2022 and October 2023. Eligible patients were started on low-dose transdermal buprenorphine (TD-Bup) initiation protocols. The intervention involved sequenced application of TD-Bup patches reaching a total of 12 patches (240\u2009\u00b5g\/h) over 24 to 48\u2009hours, with continuation of full opioid agonists. Protocol variants included: 6 patches q24h for 48\u2009hours, 6 patches q12h for 24\u2009hours, and 4 patches q8h for 24\u2009hours. Primary outcomes were the rate of successful initiation onto therapeutic doses of sublingual or extended-release depot Bup, and the incidence of opioid withdrawal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy five patients were identified. Fifty five (73%) were successfully initiated and discharged on Bup and the most common reasons for unsuccessful initiation were preference to switch to another medication for OUD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911) and withdrawal (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096). There was no significant difference between the protocol variants for successful initiation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.191). Adverse events (agitation, increased pain, insomnia, pruritus) were reported in 5 dropouts. Only 28 patients had sufficient Clinical Opioid Withdrawal Scale (COWS) scores to allow for objective assessment of withdrawal, with the remainder evaluated from full chart review. Nineteen patients had COWS score elevation\u2009&gt;\u20096 and\/or any narrative documentation of withdrawal. Three patients were felt to represent probable PW. No relationships were found between withdrawals and protocol variant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.621) or successful initiation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.082). All-cause withdrawals were associated with self-directed discharges (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>Rapid low-dose buprenorphine initiation with TD-Bup appears feasible with relatively low risk of withdrawals and PW, although a weakness is the vulnerability to underdosing patients with full opioid agonists resulting in opioid deficit withdrawal. Further prospective evaluation of d rapid low-dose buprenorphine initiation with TD-Bup against other evidence-based contemporary Bup MOUD initiations is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13722-026-00657-3","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:55:19Z","timestamp":1773384919000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["24-48\u2009h initiation by transdermal buprenorphine for the treatment of opioid use disorder in the inpatient setting: a retrospective chart review"],"prefix":"10.1186","volume":"21","author":[{"given":"Pouya","family":"Azar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor W.","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammadali","family":"Nikoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"LaBranche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S. 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He has received research funding from Vancouver Coastal Health Research Institute, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Canada Research Coordinating Committee, University of British Columbia, and VGH & UBC Hospital Foundation. JM has received honoraria for educational presentations organized by Indivior, which are unrelated to this cases series. MJI has received honorarium for educational presentations organized by Indivior and research funding from Vancouver Coastal Health Research Institute and UBC. JGSM has received financial support to his institution from the BC Ministry of Health, Health Canada, Canadian Institutes of Health Research, Public Health Agency of Canada, Genome Canada, Genome BC, Vancouver Coastal Health, VGH & UBC Hospital Foundation, Gilead Sciences, Janssen, Merck Sharp & Dohme, and ViiV Healthcare. All other co-authors report no conflicts of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"30"}}