Trial reportDrug and alcohol dependence2007
Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone.
Trial report in Drug and alcohol dependence, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 2 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis.Addiction science & clinical practice · 2022Pooled it
- Management of opioid use disorders: a national clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Guideline
- Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal.JAMA network open · 2024Trial
- Incidence of Precipitated Withdrawal During a Multisite Emergency Department-Initiated Buprenorphine Clinical Trial in the Era of Fentanyl.JAMA network open · 2023Trial
- Intranasal buprenorphine alone and in combination with naloxone: Abuse liability and reinforcing efficacy in physically dependent opioid abusers.Drug and alcohol dependence · 2016Trial
- The pharmacodynamic and pharmacokinetic profile of intranasal crushed buprenorphine and buprenorphine/naloxone tablets in opioid abusers.Addiction (Abingdon, England) · 2011Trial
- Induction of opioid-dependent individuals onto buprenorphine and buprenorphine/naloxone soluble-films.Clinical pharmacology and therapeutics · 2011Trial
- Neonatal abstinence syndrome after methadone or buprenorphine exposure.The New England journal of medicine · 2010Trial
- The relationship between primary prescription opioid and buprenorphine-naloxone induction outcomes in a prescription opioid dependent sample.The American journal on addictionsTrial
- Emergency Department-initiated standard versus high-dose buprenorphine induction (ENVISION): a randomised clinical trial protocol.BMJ open · 2026Article
- 24-48 h initiation by transdermal buprenorphine for the treatment of opioid use disorder in the inpatient setting: a retrospective chart review.Addiction science & clinical practice · 2026Article
- Buvidal/Brixadi - a long-acting injectable buprenorphine formulation for the treatment of opioid dependence.Pain management · 2025Review
- Effect of acute treatment with the glucagon-like peptide-1 receptor agonist, liraglutide, and estrus phase on cue- and drug-induced fentanyl seeking in female rats.Behavioural pharmacology · 2025Article
- Low-Dose Buprenorphine Initiation for Hospitalized Patients With Chronic Pain and Opioid Use Disorder or Opioid Misuse: Protocol for an Open-Label, Parallel-Group, Effectiveness-Implementation Randomized Controlled Trial.Substance use & addiction journal · 2025Article
- Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl.JAMA network open · 2024Article
- Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study.Journal of substance use and addiction treatment · 2024Article
- Overview of best practices for buprenorphine initiation in the emergency department.International journal of emergency medicine · 2024Article
- Early emergency department experience with 7-day extended-release injectable buprenorphine for opioid use disorder.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2023Article
- Article
- Interest in using buprenorphine-naloxone among a prospective cohort of street-involved young people in Vancouver, Canada.Journal of substance use and addiction treatment · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
rationaleAcute doses of buprenorphine can precipitate withdrawal in opioid dependent persons. The likelihood of this withdrawal increases as a function of the level of physical dependence.
objectivesTo test the acute effects of sublingual buprenorphine/naloxone tablets in volunteers with a higher level of physical dependence. The goal was to identify a dose that would precipitate withdrawal (Phase 1), then determine if withdrawal could be attenuated by splitting this dose (Phase 2).
methodsResidential laboratory study; subjects (N=16) maintained on 100mg per day of methadone. Phase 1: randomized, double blind, triple dummy, within subject study. Conditions were sublingual buprenorphine/naloxone (4/1, 8/2, 16/4, 32mg/8mg), intramuscular naloxone (0.2mg), oral methadone (100mg), or placebo. Medication conditions were randomized, but buprenorphine/naloxone doses were ascending within the randomization. Phase 2: Conditions were methadone, placebo, naloxone, 100% of the buprenorphine/naloxone dose that precipitated withdrawal in Phase 1 (full dose), and 50% of this dose administered twice in a session (split dose). Analyses covaried by trough methadone serum levels.
resultsSix subjects did not complete the study. Of the 10 who completed, 3 tolerated up to 32mg/8mg of buprenorphine/naloxone without evidence of precipitated withdrawal. For the seven completing both phases, split doses generally produced less precipitated withdrawal compared to full doses.
conclusionsThere is considerable between subject variability in sensitivity to buprenorphine's antagonist effects. Low, repeated doses of buprenorphine/naloxone (e.g., 2mg/0.5mg) may be an effective mechanism for safely dosing this medication in persons with higher levels of physical dependence.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.