A Review of Novel Methods To Support The Transition From Methadone and Other Full Agonist Opioids To Buprenorphine/Naloxone Sublingual In Both Community and Acute Care Settings

Background: Converting methadone to buprenorphine/naloxone sublingual (SL) is desirable for reasons including ease of prescribing, carries to improving function, decreased drug interactions, and decreased overdose risk. The process of conversion can be difficult given methadone's long half-life and concerns regarding the need for withdrawal before initiation. Purpose: Weaim to present several uniquemethods of converting individuals from methadone and other full opioid agonists (prescribed and illicit) to buprenorphine/naloxone SL as well as describe novel buprenorphine induction protocols to use in community and acute care settings. Methods: A review was conducted using key search databases. Review of publications in peer reviewed journals as well as expert opinions and protocols were used to synthesize this article. Discussion: A description of various protocols, their pros and cons, best setting of use, ease of use, and costs are detailed in the document. Conclusion: Several methods of conversion will provide clinicians with more tools to support transitioning people from methadone and other full agonist opioids to buprenorphine/naloxone SL, as well as reduce withdrawal concerns for buprenorphine induction.