Buprenorphine is a maintenance drug for treating opiate addiction that works by binding to the brain’s opioid receptors. The drug can reduce opioid use and overdose deaths, but it has a downside. Opioids must be avoided for 24 to 48 hours before people start taking buprenorphine; taking the drug too soon may cause opioid withdrawal symptoms during the initiation period— a barrier to treatment for many people with opioid use disorder.

The National Institute on Drug Abuse has awarded Benjamin Hayes, M.D., M.S.W., M.P.H., a five-year, $971,000 grant to develop and pilot-test a study to determine whether microdosing—starting buprenorphine at low, non-withdrawal-inducing doses and gradually increasing doses to therapeutic levels—is a better way for patients to begin taking buprenorphine. Buprenorphine microdosing has emerged as a possible way to avoid opioid withdrawal symptoms, but no one has scientifically studied whether microdosing can reduce withdrawal symptoms or increase patient compliance with the drug. Dr. Hayes will enroll 70 people with opioid use disorder in a four-week controlled trial that will randomize participants to microdosing or to standard home initiation of buprenorphine treatment. The results will indicate whether buprenorphine microdosing is effective, feasible, and safe and the extent to which withdrawal symptoms, anxiety, and cravings influence success in initiating buprenorphine therapy.

Dr. Hayes is an assistant professor of medicine at Einstein and an attending physician at Montefiore Health System. (1K23DA055933-01)