Abstract
OBJECTIVES: Among individuals with opioid use disorder using fentanyl, standard initial doses (2-4 mg) of buprenorphine may precipitate withdrawal, often preventing successful induction. Rapid low-dose induction is an emerging approach designed to mitigate this risk. This study describes a simplified rapid low-dose buprenorphine induction protocol in facilitating treatment initiation among patients presenting to an outpatient clinic. METHODS: This case series includes chart review data from nine patients with opioid use disorder treated at an outpatient substance use clinic who were initiated on buprenorphine-naloxone maintenance therapy. All had recent fentanyl use confirmed by UDS. Patients were instructed to follow a simplified induction protocol consisting of 1 mg of buprenorphine-naloxone, via 1/8th of an 8 - 2 mg sublingual film, administered at home hourly for 8 h, followed by maintenance dosing of 8 mg twice daily. Patients were advised to wait at least 24 h since last fentanyl use prior to initiating the induction protocol. Successful induction was defined as being on maintenance treatment at a follow-up appointment one week later. RESULTS: Of the nine patients who began the rapid low-dose induction protocol, seven successfully transitioned to buprenorphine-naloxone maintenance by the 7-day follow-up. Two patients did not return for follow-up. CONCLUSION: In this case series, the simplified rapid low-dose buprenorphine induction protocol was well-tolerated and 77.8% of patients using fentanyl were able to successfully initiate buprenorphine-naloxone maintenance. Benefits of this protocol are use of a single, standard dose of buprenorphine-naloxone, rapid induction timeline over only 8 h, and simple patient instructions.