Evaluating Buprenorphine/Naloxone Microdosing vs. Standard Dosing in Emergency Departments

Summary

This is a multi-centre, open-label RCT at four Emergency Departments (EDs) in British Columbia and Alberta. The purpose of the current study is to compare the effectiveness of buprenorphine/naloxone microdosing and standard dosing take-home induction regimens at enabling patients to successfully complete the induction regimen, and at retaining patients on opioid agonist therapy. We will randomize our enrolled patients to receive take-home microdosing or standard dosing packages of buprenorphine/naloxone. For the microdosing arm, patients immediately start taking low doses that increase to effective levels without requiring them to go into withdrawal. We hypothesize that ED patients provided buprenorphine/naloxone microdosing packages will be more likely to successfully complete the induction period compare to patients provided standard dosing packages. We furthermore hypothesize that those provided microdosing will be more likely to be retained in opioid agonist therapy, and will experience lower overdose, mortality, and healthcare utilization subsequent to their ED visit.

Timeline

Start

2021-07-23

Primary completion

2026-12

Completion

2027-06

Publications

• Background Moe J, Badke K, Pratt M, Cho RY, Azar P, Flemming H, Sutherland KA, Harvey B, Gurney L, Lockington J, Brasher P, Gill S, Garrod E, Bath M, Kestler A. Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study. J Am Coll Emerg Physicians Open. 2020 Oct 20;1(6):1712-1722. doi: 10.1002/emp2.12289. eCollection 2020 Dec.
• Background Moe J, Doyle-Waters MM, O'Sullivan F, Hohl CM, Azar P. Effectiveness of micro-induction approaches to buprenorphine initiation: A systematic review protocol. Addict Behav. 2020 Dec;111:106551. doi: 10.1016/j.addbeh.2020.106551. Epub 2020 Jul 11.
• Background Moe J, O'Sullivan F, Hohl CM, Doyle-Waters MM, Ronsley C, Cho R, Liu Q, Azar P. Short communication: Systematic review on effectiveness of micro-induction approaches to buprenorphine initiation. Addict Behav. 2021 Mar;114:106740. doi: 10.1016/j.addbeh.2020.106740. Epub 2020 Nov 25.

Drugs

Indications