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  1. I've done a lot of reading on how to transition problematic chronic pain non-OUD patients and I think I've got a good one. There's not a lot written about outpatient transitions for community pain patients so I've borrowed from a lot of case series like the links below. Using a single Butrans patch for 5 days, tapering down full agonist opioids over 3 and starting sublingual buprenorphine on day 3 and increasing should do it! The varying fractions of flims for bernese-style protocols just confused my patients but slapping a butrans patch on seems like an elegant solution to slow microtran
  2. Could I get advice for transitioning a problematic legacy methadone pain patient to buprenorphine? he’s on 20mg TID methadone and the traditional approach will take months. I’ve never done bupe microdosing. Any advice or protocols? I was reading there are 3 week ones. Thanks!
  3. Hi Everyone, How do you recommend starting someone on buprenorphine for chronic pain without OUD? Advising one of my colleagues on how to transition a 39y/o woman on Oxycodone 10mg four times a day, with diazepam, untreated OSA, depression, unintentional overdose after IV opioids in the ED. I've traditionally done the standard no opioids for 8-18 hours, start 4mg bupe, wait 2 hours, take another 4mg bupe, then ramp up 2nd day. My guess is she'll be on TID dosing 16-24mg/day. A colleague mentioned micro-dosing, which I haven't done before. What do you think about micro-dosing?
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