Detoxification from high-dose codeine dependence: induction onto and tapering of buprenorphine in an inpatient addiction unit

This case describes a woman in her late 20s with a history of high-dose codeine dependence, from over-the-counter and prescribed sources. She was admitted for an elective inpatient detoxification from opioids. The approach taken involved induction onto buprenorphine, which began 23.5 hours after her last codeine use, followed by a gradual reduction over 18 days. She tolerated this well, aside from mild withdrawal symptoms emerging towards the end, managed with a range of medications and psychosocial interventions. On completing this phase of treatment, she went on to a planned stay in an inpatient rehabilitation placement. This scenario illustrates the effectiveness and safety of using buprenorphine to treat codeine dependence and contributes to the limited evidence on treatments for over-the-counter opioid dependence, highlighting the need for more structured treatment pathways.