Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 8(1), e2456253. https://doi.org/10.1001/jamanetworkopen.2024.56253 Dr. Leslie W. Suen et al.
Points
- This study compared the effectiveness of 4-day and 7-day low-dose buprenorphine initiation (LDI) protocols in patients with opioid use disorder (OUD) who use fentanyl.
- Successful initiation occurred in 34% of attempts, with slightly higher success for the 4-day protocol (38%) than the 7-day protocol (28%), though the difference was not statistically significant.
- Buprenorphine retention at 28 days was low for both protocols, with 21% retention for the 4-day protocol and 18% for the 7-day protocol.
- Repeated LDI attempts significantly reduced the odds of success, with lower success rates observed on second and subsequent attempts.
- LDI of buprenorphine in fentanyl users showed low success and retention rates, highlighting the need for further refinement of LDI protocols and additional interventions to enhance treatment uptake.
Summary
This cohort study assessed the effectiveness of two low-dose buprenorphine initiation (LDI) protocols (4-day vs 7-day) in patients with opioid use disorder (OUD) who use fentanyl. Data were extracted from two substance use disorder treatment clinics in San Francisco, California, between May 2021 and November 2022. The study included 126 adults (median age 35 years, 71% male) who attempted 175 LDI protocols. The primary outcome was successful buprenorphine initiation, defined by self-reported completion of LDI and pickup of a refill prescription. Successful initiation occurred in 60 attempts (34%), with a success rate of 38% for the 4-day protocol and 28% for the 7-day protocol. Buprenorphine retention at 28 days was low, with 21% retention for the 4-day protocol and 18% for the 7-day protocol.
The study revealed no significant difference between the 4-day and 7-day LDI protocols regarding successful initiation. Logistic regression analysis adjusted for repeated attempts, age, gender identity, race, ethnicity, and housing status found no difference between protocol types in successful initiation (adjusted odds ratio [AOR] for the 7-day protocol vs 4-day: 1.05 [95% CI, 0.59–1.86]). However, repeated attempts had significantly lower odds of success: second attempt AOR 0.30 (95% CI, 0.14–0.66) and third or more attempts AOR 0.22 (95% CI, 0.09–0.53). No significant difference in retention was found between protocol types using Kaplan-Meier survival curves adjusted with Cox proportional hazards regression.
In conclusion, the LDI of buprenorphine in individuals with fentanyl use disorder shows low success and retention rates, suggesting that this approach requires further refinement. Future research should focus on improving LDI success and retention rates and exploring additional interventions to enhance buprenorphine uptake in this population.
Link to the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829504
References Suen, L. W., Chiang, A. Y., Jones, B. L. H., Soran, C. S., Geier, M., Snyder, H. R., Neuhaus, J., Myers, J. J., Knight, K. R., Bazazi, A. R., & Coffin, P. O. (2025). Outpatient low-dose initiation of buprenorphine for people using fentanyl. JAMA Network Open, 8(1), e2456253. https://doi.org/10.1001/jamanetworkopen.2024.56253
