Best Practices for Buprenorphine Induction Strategies

Opioid overdose is a leading cause of death in the United States. While buprenorphine reduces mortality by 76% for people with opioid use disorder, the rising prevalence of fentanyl and other high-potency synthetic opioids has complicated traditional induction methods. Even when best practices are followed, patients can experience increased withdrawal symptoms due to the interaction between buprenorphine and fentanyl. Withdrawal negatively affects treatment engagement, retention, and outcomes. In an addiction treatment unit at a large, southeastern academic medical center, various induction methods are used without a standardized protocol. Using Define-Measure-Analyze-Design-Verify and the CDC's Framework for Programmatic Evaluation, the team evaluated best practices for buprenorphine induction through retrospective chart analysis and focused literature review. This led to the development of an evidence-based practice protocol. In the chart review ( n = 21), 71.4% ( n = 15) of patients completed induction; withdrawal symptoms ( n = 6) were the main reason for treatment discontinuation. Only 42% of patients had a documented Clinical Opiate Withdrawal Scale score, which limited the ability to measure withdrawal. Since withdrawal symptoms pose a major barrier to successful induction, our team created a method selection and titration protocol for low-dose buprenorphine induction with overlapping opioid agonism with stakeholder feedback. Inconsistent Clinical Opiate Withdrawal Scale documentation identified in the review also supports the need to standardize withdrawal assessment.