Outpatient buprenorphine micro-induction for an older adult with chronic pain and opioid use disorder: a case report

Buprenorphine micro-induction enables a gradual transition from full opioid agonists without requiring abstinence, minimizing the risk of precipitated withdrawal. This approach is particularly beneficial for older adults with chronic pain who remain on long-term opioid therapy and may be reluctant or medically unfit to undergo traditional induction protocols. A 68-year-old woman with Ehlers-Danlos Syndrome, complex surgical history, and severe opioid use disorder who was taking 280 (Morphine Milligram Equivalents per Day), including prescribed morphine and illicit hydromorphone. She underwent an outpatient buprenorphine-naloxone micro-induction while continuing full agonist use until target dose was reached. Doses were titrated over seven days with minimal withdrawal symptoms. She successfully transitioned to buprenorphine-naloxone 4-1 mg QID (Four Times Per Day), reporting improved pain, mobility, and overall functioning. Outpatient micro-induction can be safely implemented in older adults with chronic opioid exposure, particularly those receiving prescription opioids from outside prescribers for chronic pain. This case underscores the utility of pharmacogenomics, trauma-informed care, and interdisciplinary coordination to facilitate successful transition to MOUD.