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Author Spotlight: An Efficient Methodology to Confidently Differentiate and Characterize Fentanyl Analogs
Published on: November 8, 2024
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Barriers to Buprenorphine Initiation in Patients Using Fentanyl
Sarah S Kawasaki1, Jane M Liebschutz2,3, Cristina Murray-Krezan2,4
1Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
JAMA Network Open
|January 6, 2026
Summary
Clinicians frequently encounter difficulties initiating buprenorphine (BUP) treatment for patients using fentanyl, often leading to precipitated withdrawal. Many practitioners modify standard BUP induction protocols to manage these challenges, especially in non-inpatient settings.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Research
Background:
- Anecdotal evidence suggests increased challenges in starting buprenorphine (BUP) treatment for individuals using illicitly manufactured fentanyl.
- Limited empirical data exist on the prevalence and nature of these difficulties.
Purpose of the Study:
- To determine the frequency of clinician-reported problems when initiating BUP treatment in patients using fentanyl.
- To describe clinical strategies employed to overcome challenges in BUP treatment initiation and patient engagement.
Main Methods:
- An online survey was administered to physicians and advanced practice clinicians.
- The survey collected data on patient fentanyl use, BUP induction problems (precipitated/prolonged withdrawal), and clinician-reported strategies.
- Logistic regression identified factors associated with BUP initiation problems.
Main Results:
- Over 72% of clinicians reported problems initiating BUP in patients using fentanyl.
- Over 61% reported patients experiencing precipitated withdrawal.
- Clinicians with higher patient volumes, a higher proportion of patients using fentanyl, and those practicing in non-inpatient settings were more likely to report initiation problems.
Conclusions:
- Initiating buprenorphine treatment for patients using fentanyl presents significant challenges, including precipitated withdrawal.
- Many clinicians adapt their induction procedures and counseling in response to these difficulties.
- Further research is needed to develop and validate alternative BUP induction strategies tailored to specific clinical settings.
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