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A new injectable buprenorphine protocol shows promise for treating opioid use disorder (OUD) in individuals using fentanyl, including those experiencing homelessness. High initiation, completion, and retention rates were observed in a low-threshold setting.

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Area of Science:

  • Addiction Medicine
  • Pharmacology
  • Public Health

Background:

  • Initiating buprenorphine for opioid use disorder (OUD) is challenging for fentanyl users, particularly those experiencing homelessness.
  • Novel buprenorphine initiation strategies are crucial for this population.

Purpose of the Study:

  • To evaluate short-term outcomes of an injectable-only overlapping buprenorphine starting protocol.
  • To assess the protocol's effectiveness in a low-threshold, field-based setting for individuals with OUD and active fentanyl use.

Main Methods:

  • Retrospective observational cohort study using electronic health records (September 2024 - January 2025).
  • Included patients with moderate to severe OUD using fentanyl in a low-threshold urban OUD treatment program.
  • Utilized an injectable-only overlapping buprenorphine protocol without requiring fentanyl cessation.

Main Results:

  • 95 individuals met inclusion criteria; 90% initiated the protocol.
  • 75% completed the protocol, and 64% achieved 2-month retention.
  • The study population predominantly experienced homelessness (79%).

Conclusions:

  • The injectable-only overlapping buprenorphine protocol demonstrated high initiation, completion, and retention rates.
  • This novel protocol is a promising strategy for initiating buprenorphine in outpatient settings for fentanyl users, including those who are homeless.
  • Low-threshold, field-based care facilitates access to OUD treatment.