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A loading dose is an essential pharmacological strategy to rapidly achieve the target plasma drug concentration necessary for an immediate therapeutic effect. This approach is especially critical for drugs characterized by slow absorption or extended half-lives, where delaying therapeutic plasma levels could compromise treatment outcomes. By administering a loading dose, clinicians ensure a prompt onset of drug action, even for agents with complex pharmacokinetic profiles.Achieving steady-state...
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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Best Practices for Buprenorphine Induction Strategies.

Jessica L Skarda1, Rachel M Sasser, Ashley D Johnson

  • 1Jessica L. Skarda, Rachel M. Sasser, Ashley D. Johnson, and Susanne A. Fogger, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.

Journal of Addictions Nursing
|November 18, 2025
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Summary
This summary is machine-generated.

Buprenorphine induction for opioid use disorder is challenging with fentanyl. A new protocol using low-dose buprenorphine and overlapping opioid agonism can improve treatment engagement and reduce withdrawal symptoms.

Keywords:
BuprenorphineClinical Opiate Withdrawal ScaleOpioid InductionOpioid Withdrawal

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Area of Science:

  • Addiction Medicine
  • Pharmacology
  • Public Health

Background:

  • Opioid overdose remains a critical public health issue in the US.
  • Buprenorphine significantly reduces mortality for opioid use disorder (OUD).
  • High-potency synthetic opioids like fentanyl complicate buprenorphine induction and increase withdrawal.

Purpose of the Study:

  • To evaluate best practices for buprenorphine induction.
  • To develop an evidence-based protocol to improve induction success.
  • To address challenges posed by fentanyl and withdrawal symptoms.

Main Methods:

  • Utilized Define-Measure-Analyze-Design-Verify and CDC's Framework for Programmatic Evaluation.
  • Conducted retrospective chart analysis (n=21) and a focused literature review.
  • Developed a standardized protocol for low-dose buprenorphine induction with overlapping opioid agonism.

Main Results:

  • Withdrawal symptoms were the primary reason for treatment discontinuation (n=6).
  • Only 42% of patients had documented Clinical Opiate Withdrawal Scale (COWS) scores, hindering assessment.
  • The developed protocol aims to standardize assessment and improve induction outcomes.

Conclusions:

  • Standardized withdrawal assessment, particularly using the COWS scale, is crucial.
  • A low-dose buprenorphine induction protocol with overlapping opioid agonism can mitigate withdrawal.
  • Evidence-based protocols are needed to optimize buprenorphine treatment engagement and retention for OUD.