Of the estimated 2.5 million people in the US currently experiencing OUD, just over 20% have received medication-assisted treatment. This is a concerningly low number, considering what we know about the long-term benefits and costs of different treatment options. One major factor in treatment is the reality of facing withdrawal, which can even be caused by the medications prescribed for treatment. This is why a form of microdosing called the Bernese method is gaining traction online and in research and treatment circles.
What is the Bernese method?
The Bernese method is a medication-assisted opioid treatment that seeks to use buprenorphine—known colloquially as bupe and often sold mixed with naloxone under the brand name Suboxone®—to avoid precipitated withdrawal (important safety information). Buprenorphine is a partial opioid agonist commonly used in OUD treatment due to its favorable side effects and opioid ceiling effect. Essentially, it competes with other opioids, such as oxycodone or fentanyl, in the brain while only offering a minor version of the intoxicating effects of the opioid family. Bupe is generally considered safer than other opioids and can help minimize cravings while undergoing treatment.
Unlike regular withdrawal, which is caused by a lack of opioids in the system, precipitated withdrawal generally occurs when drugs used for treatment force other opioids out of the brain, triggering withdrawal. Precipitated withdrawal can be sudden, severe, and highly uncomfortable, although it’s rarely dangerous. The severity of these withdrawal symptoms threatens the success of OUD treatment, as many patients relapse in an effort to ease the discomfort.
The Bernese method—named for its origins in Bern, Switzerland—was developed to slowly introduce buprenorphine into a patient’s system to prevent the sudden onset of withdrawal symptoms. It’s basically a Suboxone microdosing technique with the potential to make OUD treatment more effective for certain patients.
The Bernese method also seems to be highly regarded among opioid users, according to anecdotal data gathered from social media. In forums where opioid use disorder patients discuss their treatment, the Bernese method is frequently brought up as a method that may work where other treatment inductions have failed. While these claims are difficult to prove, these first-hand experiences are a valuable starting point for evidence in the Bernese method’s favor.
How does the Bernese method differ from standard methods?
The standard method of buprenorphine treatment induction involves a period of opioid abstinence that can last from just a few days to over a week, depending on an individual patient’s circumstances. After that point, patients are prescribed a steady dose of sublingual buprenorphine. This induction method is more likely to result in withdrawal symptoms, either natural or precipitated, which can be uncomfortable for the patient.
Why do treatment experts think about this method?
Addiction treatment experts are always on the lookout for more effective treatment methods for opioid use disorder, and many consider the Bernese method worthy of further research. This method may be especially useful for opioid users who frequently take fentanyl, which requires a significantly longer abstinence period before OUD treatment can begin—and this period is risky. Each day of abstinence is a day that a patient has an increased risk of relapse. Additionally, it’s not entirely clear how long an individual needs to abstain from fentanyl before they can safely take Suboxone without the risk of precipitated withdrawal.
It’s also apparent that this method can be used when transitioning a patient between full agonist treatments–such as those done with methadone–and a partial agonist treatment using buprenorphine. This transition needs to be handled carefully so that the patient stays safe and healthy, and transitioning correctly can increase the likelihood of treatment failing in the long term.
What’s the current state of research?
At the moment, research into the efficacy of the Bernese method is in its infancy, but the early results are promising. Some researchers have found that patients are amenable to microdosing Suboxone, and others have done case studies showing that the Bernese method has been effectively used to taper full agonist treatments into partial agonist ones. Ophelia clinicians’ own research saw a 90% success rate with patients undergoing home inductions using a modified version of the Bernese method that includes adjunctive medications. More research certainly needs to be done, but these results are likely to spur further inquiry.