Simplified rapid low-dose buprenorphine induction method for individuals using fentanyl: a case series

Area of Science:

• Addiction Medicine
• Pharmacology

Background:

• Standard buprenorphine induction doses can precipitate withdrawal in fentanyl users, hindering treatment initiation.
• Rapid low-dose induction is an emerging strategy to mitigate this risk.
• Fentanyl's prevalence necessitates effective buprenorphine induction protocols.

Purpose of the Study:

• To describe a simplified rapid low-dose buprenorphine induction protocol.
• To assess the feasibility and success rate of this protocol in an outpatient setting.
• To evaluate the tolerability of the protocol in patients with fentanyl use disorder.

Main Methods:

• A case series of nine patients with opioid use disorder and recent fentanyl use was reviewed.
• Patients followed a simplified protocol: 1 mg buprenorphine-naloxone hourly for 8 hours at home.
• Successful induction was defined as maintenance treatment at 1-week follow-up.

Main Results:

• Seven out of nine patients (77.8%) successfully transitioned to buprenorphine-naloxone maintenance.
• Two patients did not complete the 7-day follow-up.
• The protocol was generally well-tolerated.

Conclusions:

• A simplified rapid low-dose buprenorphine induction protocol is effective for initiating treatment in fentanyl users.
• The protocol's benefits include a single standard dose, rapid 8-hour induction, and simple instructions.
• This method shows promise for improving buprenorphine initiation rates in outpatient settings.