Initiating Buprenorphine for Patients Using Fentanyl

Presented by Brian Hurley, MD, MBA, DFASAM, FAPA, President-Elect; American Society of Addiction Medicine. Recorded 7-April-2023, visit https://intnsa.org/elearning-portal/v.... The United States is currently experiencing the worst overdose crisis in our history, driven by the increasing potency and variety of opioids, central nervous system depressants, and stimulants present throughout the drug supply. Treatment of opioid use disorder with buprenorphine is a well demonstrated and empirically validated intervention that reduces opioid use, reduces the risk of overdose, and increases treatment retention. Fentanyl’s increasingly presence within the United States’ drug supply is associated with increasingly common clinical challenge of buprenorphine-precipitated withdrawal during standard dosing approaches, due to fentanyl’s pharmacologic properties. Despite these challenges, patients with opioid use disorder involving fentanyl as compared with opioid use disorder without fentanyl are both well demonstrated to experience similar rates of treatment retention after buprenorphine is initiated. There is not yet a consensus on a uniform consensus on how to best adapt buprenorphine initiation protocols for patients whose opioid use disorder involves fentanyl. This webinar will review variations on buprenorphine dosing that can be considered for patients with opioid use disorder involving fentanyl. The presenters will review the evidence for and describe low dose buprenorphine initiation of protocols, high dose buprenorphine initiation of protocols, approaches to help support patients stop using full agonist opioids for a longer period of time, and a clinical approach to referring patients to alternative medications for opioid use disorder.