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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
Summary
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.
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.
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