Buprenorphine dose induction in non-opioid-tolerant pre-release prisoners

Drug Alcohol Depend. 2015 Nov 1;156:133-138. doi: 10.1016/j.drugalcdep.2015.09.001. Epub 2015 Sep 7.


Background: In a previously reported randomized controlled trial, formerly opioid-dependent prisoners were more likely to enter community drug abuse treatment when they were inducted in prison onto buprenorphine/naloxone (hereafter called buprenorphine) than when they received counseling without buprenorphine in prison (47.5% vs. 33.7%, p=0.012) (Gordon et al., 2014). In this communication we report on the results of the induction schedule and the adverse event profile seen in pre-release prisoners inducted onto buprenorphine.

Method: This paper examines the dose induction procedure, a comparison of the proposed versus actual doses given per week, and side effects reported for 104 adult participants who were randomized to buprenorphine treatment in prison. Self-reported side effects were analyzed using generalized estimated equations to determine changes over time in side effects.

Results: Study participants were inducted onto buprenorphine at a rate faster than the induction schedule. Of the 104 (72 males, 32 females) buprenorphine recipients, 64 (37 males, 27 females) remained on medication at release from prison. Nine participants (8.6%) discontinued buprenorphine because of unpleasant opioid side effects. There were no serious adverse events reported during the in-prison phase of the study. Constipation was the most frequent symptom reported (69 percent).

Conclusion: Our findings suggest that buprenorphine administered to non-opioid-tolerant adults should be started at a lower, individualized dose than customarily used for adults actively using opioids, and that non-opioid-tolerant pre-release prisoners can be successfully inducted onto therapeutic doses prior to release.

Keywords: Buprenorphine dose; Buprenorphine induction; Opioid-dependent prisoners.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Buprenorphine, Naloxone Drug Combination / administration & dosage*
  • Counseling
  • Female
  • Humans
  • Male
  • Middle Aged
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / drug therapy*
  • Prisoners*
  • Prisons


  • Analgesics, Opioid
  • Buprenorphine, Naloxone Drug Combination