One-Day Induction of XR Buprenorphine Feasible for Fentanyl Use in OUD

Rapid induction to extended-release buprenorphine 300-mg injection feasible and well tolerated for those using fentanyl

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Nov. 8, 2023 (HealthDay News) — For individuals with opioid use disorder (OUD) using fentanyl, a one-day induction of extended‐release buprenorphine is a feasible treatment approach, according to a study published online Nov. 8 in the American Journal on Addiction.

John J. Mariani, M.D., from the New York State Psychiatric Institute in New York City, and colleagues conducted a secondary analysis of results grouped by fentanyl use status for an open‐label study with rapid induction of extended‐release buprenorphine in the inpatient research unit. A single 4-mg dose of transmucosal buprenorphine (BUP‐TM) was administered to eligible participants, followed by an extended‐release buprenorphine 300-mg injection (BUP‐XR) after approximately one hour. Follow-up was continued to six months in an extension study (six monthly injections).

All 19 participants with fentanyl‐positive urine samples (FEN+) received BUP-TM, 17 received BUP-XR, 13 chose to receive a second BUP-XR, and 10 received all six scheduled injections. All seven participants with fentanyl-negative urine samples (FEN−) received BUP-TM and BUP-XR, four elected to receive a second injection, and two received all six injections. The FEN+ and FEN− groups had similar induction-day clinical opioid withdrawal scale (COWS) scores. Within 24 hours of BUP-XR injection, mean COWS scores fell to below 5 in the FEN+ group.

“Fentanyl and other synthetic opioids are the leading cause of overdose deaths in the United States and rapid induction to BUP‐XR injection may be an important potential treatment option for this at‐risk population,” the authors write.

Several authors disclosed ties to Indivior, which funded the study.

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