How do you approach switching from methadone to buprenorphine/naloxone for patients who want to change medication management for opioid use disorder?  

All of the above opinions are valid. I can guarantee, my dear colleagues, that if three hours are spent in one room, we could easily come to 5 different solutions and would be able to justify them.  What is important is the reason for the switch, the comfort of the person who is switching, and...

The switching of patients with opioid use disorder from methadone to suboxone (buprenorphine/naloxone) is increasingly common and important, given the safety and comparative effectiveness of suboxone to methadone for treating opioid use disorder and preventing opioid overdoses. The general principl...

To start, beware of switching in high-risk patients, (i.e., heavy IVDU history, other substance use besides opioids [Ferri et al., PMID 24313243]). Establish that other risk factors are addressed/resolved (housing, financial, psychiatric, and medical) before embarking on the transition.Once the...

The fear of "buprenorphine precipitated withdrawal" in transitioning to buprenorphine in a patient who has been on methadone is something to be aware of and not be afraid of.  The basic principle is that buprenorphine displaces methadone from the mu opioid receptor but has considerably less ago...

Reduce the dose of methadone gradually to around 30 mg then switch to buprenorphine titration while stopping methadone.

Better to titrate down methadone to 30 mg, try Suboxone micro-dosing, wait for the 24-36 hour window, if needed, then titrate Suboxone dosing.