The Howard Street Method: A Community Pharmacy-led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals...

Area of Science:

• Pharmacology
• Public Health
• Addiction Medicine

Background:

• Buprenorphine treatment is crucial for reducing opioid use disorder (OUD) morbidity and mortality.
• Fear of precipitated withdrawal deters patients, especially those using synthetic opioids like fentanyl, from initiating buprenorphine.
• Novel initiation protocols are needed to overcome these barriers in diverse patient populations.

Purpose of the Study:

• To evaluate the development and implementation of a buprenorphine low dose overlap initiation (LDOI) protocol.
• To assess the clinical outcomes of the "Howard Street Method" for initiating buprenorphine in patients using fentanyl.
• To determine the viability of a community pharmacy-based LDOI protocol for an underresourced population.

Main Methods:

• Retrospective chart review of 27 patients with nonprescribed fentanyl use.
• Analysis of buprenorphine LDOI schedule (Howard Street Method) dispensed from a community pharmacy.
• Evaluation of patient adherence, withdrawal symptoms, opioid use, and retention in care.

Main Results:

• 14 out of 27 patients completed the LDOI protocol.
• Of completers, 79% reported no withdrawal symptoms and 21% reported mild symptoms.
• 4 patients (29%) ceased full opioid agonist use, while 10 (71%) reduced use.
• At 180 days, 43% were retained in care and 14% continued buprenorphine treatment.

Conclusions:

• A community pharmacy-based LDOI blister-pack protocol is a viable intervention for initiating buprenorphine.
• The Howard Street Method shows promise as an alternative buprenorphine initiation strategy.
• This protocol is particularly relevant for underresourced, safety-net populations with fentanyl use.