Parents Supporting Transition Process from Fentanyl to Buprenorphine-Naloxone at Home

Dr. Wesley Sassaman, DNP, MSN-NE, MPH, MBA, FNP-C, CARN-AP

Overview

Transitioning from street-based fentanyl to buprenorphine-naloxone represents a viable and evidence-based pathway to recovery. Despite the challenges posed by fentanyl’s potency and unpredictable composition, an in-home transition process is achievable through personalized care, strategic induction methods, and appropriate medical supervision. The benefits of this transition include reducing withdrawal symptoms, stabilizing cravings, and fostering long-term recovery. Parents can play a significant role in helping their teen or young adults transition form street-based fentanyl to buprenorphine-naloxone or just buprenorphine alone. Having the focused attention of parents and a seasoned addiction provider, providing services virtually, can go a long way to making a difficult transition into a comfortable one in the comfort of one's own home.

Benefits of Transitioning to Buprenorphine-Naloxone (or just Buprenorphine w/o Naloxone)

• Effective Withdrawal Management:

  • Buprenorphine-naloxone mitigates the severe withdrawal symptoms associated with fentanyl cessation, making recovery more manageable.

• Cravings Reduction:

  • These medications work to significantly reduce opioid cravings, offering a stable foundation for recovery.

• Safe and Controlled Process:

  • With healthcare support, transitioning becomes a medically controlled process, reducing the risks associated with abrupt detox from fentanyl.

• Improved Quality of Life:

  • Transitioning allows patients to rebuild their lives, focus on rehabilitation, and mend relationships affected by opioid dependency.

Role of Parents

• Supporting the Patient:

  • Parents provide emotional and logistical support throughout the treatment process, creating a stable and encouraging environment.

• Monitoring Treatment:

  • Parents may assist with medication adherence and act as active partners in their loved one’s recovery.

• Pretreating Before First Bup-Nx dose

  • Ondansetron use as prophylaxis against nausea/vomit which is common

  • Ibuprofen 800 mg TID with food for generalized whole body pain

  • Hydroxyzine 50 MG up to 4x/day for generalized anxiety

  • Clonidine 0,1 mg TID for sympathetic agitation (hold if BP is < 120/80

  • 
    

Induction Methods

• Standard Induction:

  • Start with 2-4 mg of buprenorphine and increase doses based on withdrawal severity.

• Rapid Crossover (3 Days):

  • Introduce buprenorphine over three days while tapering full agonist opioids.

• 7-Day Crossover:

  • Extend the crossover process for reduced discomfort.

• Microdosing Strategy:

  • Gradually introduce small amounts of buprenorphine alongside full agonist opioids, minimizing withdrawal risks during transition.

• Quick-Start Induction:

  • A fast method involving naloxone-induced withdrawal, followed by buprenorphine initiation.

Challenges and Overcoming Barriers

Potential Challenges with Street-Based Fentanyl

• High Potency:

  • Fentanyl’s potency surpasses other opioids, complicating the transition to buprenorphine-naloxone. This can lead to intense withdrawal symptoms if not properly managed.

• Long Storage in Fat Tissue:

  • Fentanyl may linger in the body, prolonging withdrawal symptoms and complicating the timing for buprenorphine initiation.

• Uncertain Adulterants:

  • Street-based fentanyl often contains other substances, making withdrawal unpredictable.

Strategies to Overcome Challenges

• Microdosing as a Strategy:

  • Employing the microdosing method ensures a smoother, gradual transition without precipitating severe withdrawal.

• Medical Supervision:

  • Frequent monitoring by healthcare providers ensures the correct timing and dosing of buprenorphine-naloxone.

• Comfort Medications:

  • A range of medications like clonidine, gabapentin, and others help alleviate withdrawal symptoms, improving patient comfort and safety.

• Blood Pressure Monitoring:

  • Using a digital blood pressure monitor during medications like clonidine safeguards patient health by keeping fluctuations in check.

Importance of Blood Pressure Monitoring

• Why It Matters:

  • Clonidine, used to manage withdrawal-related anxiety, can lower blood pressure. Monitoring ensures safety and effective treatment.

• Using a Digital Blood Pressure Monitor:

  • Patients track their blood pressure regularly and share records with healthcare providers for timely adjustments to treatment.

Use of Telehealth

• Easier Access:

  • Telehealth bridges barriers for patients in rural locations, providing consistent support and access to care.

• Personalized Care:

  • Virtual follow-ups and treatment adjustments help tailor plans to each patient’s needs.

Importance of Personalized Care

• Customized Plans:

  • Every patient's transition is unique; care plans focus on individual histories and health needs.

• Holistic Recovery:

  • Address emotional and social factors alongside medical treatment to support long-term recovery.

• Flexibility:

  • Personalized methods, like adjusting induction dosages, empower providers to adapt to changing circumstances.

A Viable Path Forward

Transitioning from street-based fentanyl to buprenorphine-naloxone is not just viable but increasingly recognized as the safest and most effective route to recovery. With appropriate guidance, careful monitoring, and strategies to address the distinct challenges that fentanyl presents, patients have a proven pathway to regaining stability and achieving long-term health.

Goal of the Transition

• Stable Recovery:

  • Provide patients with a stabilized state free from severe withdrawals and debilitating cravings.

• Enhanced Quality of Life:

  • Restore normalcy, foster resilience, and facilitate reintegration into everyday life.

By emphasizing the viability of this transition and offering tailored solutions to overcome challenges, individuals battling fentanyl dependency can access renewed hope and a clear path to recovery.