• Jessica Moe, Fiona O'Sullivan, Corinne M Hohl, Mary M Doyle-Waters, Claire Ronsley, Raymond Cho, Qixin Liu, and Pouya Azar.
• Department of Emergency Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z IM9, Canada; Department of Emergency Medicine, Vancouver General Hospital, 920 West 10(th) Avenue, Vancouver, British Columbia V5Z 1M9, Canada; BC Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia V5Z 4R4, Canada. Electronic address: jessica.moe@ubc.ca.
• Addict Behav. 2021 Mar 1; 114: 106740.

Background/ObjectivesMicro-induction is a novel buprenorphine induction approach that seeks to avoid withdrawal and minimize precipitated withdrawal, both barriers to standard inductions. We aimed to synthesize evidence on micro-induction effectiveness, and regimens described.MethodsWe searched scientific databases and grey literature for studies including adolescents or adults with opioid use disorder who received buprenorphine micro-induction. Study selection, data extraction and quality assessments occurred in duplicate. We narratively synthesized results.ResultsWe screened 4,752 citations and included 19 case studies/series and one feasibility study (n = 57 patients; mean age 38 years [SD 12.0]; 57.9% male [33/57]). Studies described 26 regimens; starting and maintenance doses ranged from 0.03 to 1.0 mg, and 8 to 32 mg, respectively. We calculated rate of increase to 8 mg. All patients achieved the desired maintenance dose. Among 54 patients in whom precipitated withdrawal was not reported, mean increases were 1.36 mg/day (SD 0.41). For three patients in whom precipitated withdrawal was specifically reported, mean increase was 1.17 mg/day (SD 0.11). All studies were low quality.DiscussionDescribed regimens are highly variable. Inconsistent reporting, selection bias, and poor quality evidence limit conclusions regarding optimal dosing, and patient characteristics and clinical settings in which micro-induction is likely beneficial.ConclusionsThis systematic review provides the most up-to-date synthesis on buprenorphine micro-induction regimens. Rigorous studies evaluating effectiveness and safety of micro-induction, and patient and clinical factors influencing its success, are needed.Copyright © 2020 Elsevier Ltd. All rights reserved.

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