Clinical Pharmacy Forum
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Service or Program:
Buprenorphine is used to treat opioid use disorder, however it is challenging to initiate in patients with concomitant pain as it requires an opioid-free period to avoid precipitated withdrawal. Micro-induction (MI) is an alternative approach where buprenorphine is slowly introduced over several days while opioid therapy is continued until reaching the target dose of buprenorphine. Published reports typically use a consult service to manage this transition, however our hospital does not have an inpatient chemical dependency (CD) service. In 2022, two pharmacist specialists began a program to identify adult inpatients that may benefit from MI.
Justification/Documentation:
Pharmacists discussed each case with an outpatient CD provider within the health system, who contacted each patient to consider MI as an alternative to traditional initiation of buprenorphine. Pharmacists entered individualized orders for each patient, discussed the process with the care team, and followed patients daily during MI. MI was done using 150 mcg films for the initial doses followed by 2 and 8 mg tablets until the target dose was reached. A total of 8 patients were started on the MI protocol and none experienced precipitated withdrawal during the titration period. Opioids were successfully discontinued after the maintenance dose was reached.
Adaptability:
This process allows for adaptation to hospitals that do not have a CD consult service on-site. Although our program used physician collaboration to contact the patient and explain the protocol, this step could also be carried out by a clinical pharmacist. This process is easily modifiable to staffing needs of individual institutions.
Significance:
This pharmacist-driven service provides a novel approach to treat a complex medication issue, especially as hospitalists are frequently unfamiliar with buprenorphine management. Pharmacists are a valuable resource when using MI to initiate buprenorphine without stopping opioids for treatment of pain.
Presenting Author
Christine A. Hamby Pharm.D, BCPSRochester General Hospital
Authors
Fatma Akmese MD
Rochester General Hospital
Richard Dent MD
Rochester Regional Health
Taylor Rider Pharm.D., BCPS
Rochester General Hospital