{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:31:37Z","timestamp":1773930697470,"version":"3.50.1"},"reference-count":15,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Buprenorphine is a partial mu opioid agonist that has been increasingly utilized to treat patients with chronic pain and opioid use disorder (OUD). The drug has proven to provide significant chronic pain relief at low doses ranging from 75 to 1800\u00a0mcg. The conventional buprenorphine transitional process delays its introduction until patients begin withdrawal. However, this process can\u00a0pose a barrier to both patients and providers due to some patients\u2019 inability to tolerate traditional prerequisite withdrawal. To our knowledge, this is a rare reported case\u00a0to describe a transitional process utilizing buccal buprenorphine in which a patient with chronic pain simultaneously tapered completely off an extended-release (ER) full opioid agonist and uptitrated buprenorphine. The patient was weaned from oxycodone ER 30\u00a0mg every 12\u00a0h and oxycodone\/acetaminophen 10\/325\u00a0mg 3x\/day for breakthrough pain utilizing an unconventional approach. Tapering down to oxycodone ER 20\u00a0mg 2x\/day for the first 2\u00a0weeks was successful. However, reducing to oxycodone ER\u00a010\u00a0mg 2x\/day for the following 2\u00a0weeks presented adherence difficulty and increased breakthrough pain. At this time, buccal buprenorphine was added at 300 mcg daily for 3\u00a0days. From days 4 to 6, buprenorphine was increased to 300\u00a0mcg 2x\/day and oxycodone ER decreased to 10\u00a0mg daily. Six days later, oxycodone ER was\u00a0discontinued and oxycodone\/acetaminophen continued as needed. The patient exhibited no signs of withdrawal and\u00a0adequate relief of symptoms through this tapering process. At the 1-month follow-up, the patient was doing well and was being treated solely with buprenorphine and oxycodone\/acetaminophen to control her breakthrough pain. After 5\u00a0months, buprenorphine was increased to 600\u00a0mcg 2x\/day and her oxycodone\/acetaminophen decreased to 5\/325\u00a0mg 3x\/day as needed. From the start of\u00a0the patient\u2019s taper to her current transition, the patient\u00a0reduced her morphine milligram equivalent (MME)\u00a0dosage from 135 MME to 22.5 MME. The Clinical Opioid Withdrawal Scale (COWS), which measures the severity of a patient\u2019s opioid withdrawal symptoms, was consistently less than 5. This buprenorphine schedule demonstrated a successful tapering approach for this patient because she had reported improved quality of life and function. A patient-centered osteopathic treatment approach was utilized when the patient presented with mid-taper adherence difficulty. Transitioning patients from\u00a0full to partial opioid agonists could become an important practice standard for patient safety not only for\u00a0formal pain management practices but also in primary care, family practice, and even geriatric offices.<\/jats:p>","DOI":"10.1515\/jom-2022-0075","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T18:44:31Z","timestamp":1666723471000},"page":"1-5","source":"Crossref","is-referenced-by-count":2,"title":["Successful buprenorphine transition while overlapping with a full opioid agonist to treat chronic pain: a case report"],"prefix":"10.1515","volume":"123","author":[{"given":"Kishan V.","family":"Patel","sequence":"first","affiliation":[{"name":"Rowan University School of Osteopathic Medicine , Stratford , NJ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sidharth","family":"Sahni","sequence":"additional","affiliation":[{"name":"Rowan University School of Osteopathic Medicine , Stratford , NJ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanvin F.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Neuro Musculoskeletal Institute, Rowan University School of Osteopathic Medicine , Stratford , NJ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"2022122220523325430_j_jom-2022-0075_ref_001","doi-asserted-by":"crossref","unstructured":"Webster, L, Gudin, J, Raffa, RB, Kuchera, J, Rauck, R, Fudin, J, et al.. Understanding buprenorphine for use in chronic pain: expert opinion. Pain Med 2020;21:714\u201323. https:\/\/doi.org\/10.1093\/pm\/pnz356.","DOI":"10.1093\/pm\/pnz356"},{"key":"2022122220523325430_j_jom-2022-0075_ref_002","unstructured":"Dosing & Titration: BELBUCA\u00ae (buprenorphine buccal film). Belbuca\u00ae; 2022. Available from: https:\/\/www.belbuca.com\/hcp\/buprenorphine-dosing-titration [Accessed 5 Feb\u00a02022]."},{"key":"2022122220523325430_j_jom-2022-0075_ref_003","doi-asserted-by":"crossref","unstructured":"Sen, S, Arulkumar, S, Cornett, EM, Gayle, JA, Flower, RR, Fox, CJ, et al.. New pain management options for the surgical patient on methadone and buprenorphine. Curr Pain Headache Rep 2016;20:16. https:\/\/doi.org\/10.1007\/s11916-016-0549-9.","DOI":"10.1007\/s11916-016-0549-9"},{"key":"2022122220523325430_j_jom-2022-0075_ref_004","doi-asserted-by":"crossref","unstructured":"Robbins, JL, Englander, H, Gregg, J. Buprenorphine microdose induction for the management of prescription opioid dependence. J Am Board Fam Med 2021;34:S141\u20136. https:\/\/doi.org\/10.3122\/jabfm.2021.S1.200236.","DOI":"10.3122\/jabfm.2021.S1.200236"},{"key":"2022122220523325430_j_jom-2022-0075_ref_005","doi-asserted-by":"crossref","unstructured":"Wesson, DR, Ling, W. The clinical opiate withdrawal scale (COWS). J\u00a0Psychoact Drugs 2003;35:253\u20139. https:\/\/doi.org\/10.1080\/02791072.2003.10400007.","DOI":"10.1080\/02791072.2003.10400007"},{"key":"2022122220523325430_j_jom-2022-0075_ref_006","doi-asserted-by":"crossref","unstructured":"Adams, KK, Machnicz, M, Sobieraj, DM. Initiating buprenorphine\u00a0to treat opioid use disorder without prerequisite withdrawal: a\u00a0systematic review. Addiction Sci Clin Pract 2021;16:36. https:\/\/doi.org\/10.1186\/s13722-021-00244-8.","DOI":"10.1186\/s13722-021-00244-8"},{"key":"2022122220523325430_j_jom-2022-0075_ref_007","unstructured":"Highlights of prescribing information; 2015. Available from: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2015\/207932s000lbl.pdf [Accessed 11 Mar 2022]."},{"key":"2022122220523325430_j_jom-2022-0075_ref_008","doi-asserted-by":"crossref","unstructured":"H\u00e4mmig, R, Kemter, A, Strasser, J, von Bardeleben, U, Gugger, B, Walter, M, et al.. Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist\u00a0use: the Bernese method. Subst Abuse Rehabil 2016;7:99\u2013105. https:\/\/doi.org\/10.2147\/SAR.S109919.","DOI":"10.2147\/SAR.S109919"},{"key":"2022122220523325430_j_jom-2022-0075_ref_009","unstructured":"Suzuki, J. Psychopharmacology Institute; 2017. Available from: https:\/\/psychopharmacologyinstitute.com\/section\/buprenorphine-for-opioid-use-disorder-mechanism-of-action-2037-4002 [Accessed 11 Mar 2022]."},{"key":"2022122220523325430_j_jom-2022-0075_ref_010","doi-asserted-by":"crossref","unstructured":"Rozylo, J, Mitchell, K, Nikoo, M, Durante, SE, Barbic, SP, Lin, D, et al.. Case report: successful induction of buprenorphine\/naloxone using a microdosing schedule and assertive outreach. Addiction Sci Clin Pract 2020;15:2. https:\/\/doi.org\/10.1186\/s13722-020-0177-x.","DOI":"10.1186\/s13722-020-0177-x"},{"key":"2022122220523325430_j_jom-2022-0075_ref_011","doi-asserted-by":"crossref","unstructured":"Jerome, JA. An osteopathic approach to chronic pain management. J Am Osteopath Assoc 2017;117:306\u201314. https:\/\/doi.org\/10.7556\/jaoa.2017.056.","DOI":"10.7556\/jaoa.2017.056"},{"key":"2022122220523325430_j_jom-2022-0075_ref_012","unstructured":"Kuchera, ML. Applying osteopathic principles to formulate treatment for patients with chronic pain. J Am Osteopath Assoc 2007;107:ES28\u201338."},{"key":"2022122220523325430_j_jom-2022-0075_ref_013","doi-asserted-by":"crossref","unstructured":"Baldini, A, Von Korff, M, Lin, EH. A review of potential adverse effects of long-term opioid therapy: a practitioner\u2019s guide. Prim Care Companion CNS Disord 2012;14:PCC.11m01326.","DOI":"10.4088\/PCC.11m01326"},{"key":"2022122220523325430_j_jom-2022-0075_ref_014","unstructured":"Tapering and discontinuing opioid use. Minnesota opioid guidelines; 2021. Available from: https:\/\/mn.gov\/dhs\/opip\/opioid-guidelines\/tapering-opioids\/#:\u223c:text=There%20are%20three%20reasons%20to,the%20current%20dose%20and%20the [Accessed 11 Mar 2022]."},{"key":"2022122220523325430_j_jom-2022-0075_ref_015","unstructured":"Gold, J. Prescribing opioids to seniors: it\u2019s a balancing act. Kaiser Health News; 2021. Available from: https:\/\/khn.org\/news\/prescribing-opioids-to-seniors-its-a-balancing-act\/ [Accessed 11 Mar 2022]."}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2022-0075\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2022-0075\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T20:53:23Z","timestamp":1671742403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jom-2022-0075\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,8,30]]},"published-print":{"date-parts":[[2022,12,23]]}},"alternative-id":["10.1515\/jom-2022-0075"],"URL":"https:\/\/doi.org\/10.1515\/jom-2022-0075","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,25]]}}}