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Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl
Leslie W Suen1, Amy Y Chiang1, Benjamin L H Jones2
1Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco.
JAMA Network Open
|January 24, 2025
Summary
Low success rates were observed for buprenorphine initiation using low-dose initiation (LDI) protocols in patients with opioid use disorder (OUD) who use fentanyl. Further research is needed to improve buprenorphine uptake and retention.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- High-potency opioids like fentanyl complicate buprenorphine initiation due to precipitated withdrawal risks.
- Low-dose initiation (LDI) is explored as a strategy, but comparative outcome data are lacking.
Purpose of the Study:
- To evaluate outpatient outcomes of two LDI protocols for buprenorphine initiation in individuals with opioid use disorder (OUD) using fentanyl.
- To compare the success and retention rates between 4-day and 7-day LDI protocols.
Main Methods:
- A cohort study analyzed data from 126 adults with OUD and daily fentanyl use across two clinics.
- Data included 175 buprenorphine initiation attempts using either a 4-day or 7-day LDI protocol.
- Outcomes measured were successful initiation (completion and refill) and 28-day retention, analyzed using logistic regression and survival models.
Main Results:
- Overall successful buprenorphine initiation was 34%, with no significant difference between 4-day (38%) and 7-day (28%) LDI protocols.
- Buprenorphine retention at 28 days was low (21% for 4-day, 18% for 7-day), with no significant difference between protocols.
- Repeated LDI attempts were associated with lower odds of success.
Conclusions:
- Outpatient LDI for buprenorphine initiation in fentanyl-using OUD patients yielded low success and retention rates.
- Interventions are needed to enhance LDI success, buprenorphine uptake, and patient retention in treatment.
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