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Novel Intervention Enables Transition from Fentanyl to Buprenorphine in 1 Hour
Fewer than 3 hours after his last use of illicitly manufactured fentanyl, a 33-year-old man with opioid use disorder was able to fully transition to a therapeutic dose of buprenorphine-naloxone by first self-administering intranasal naloxone, according to a case report published online ahead of print in the Journal of Addiction Medicine.
“Although he did anticipate—and experience—moderately severe withdrawal after naloxone, the symptoms were predictable and short-lived. In essence, he transitioned from fentanyl to a therapeutic dose of buprenorphine-naloxone in less than 30 minutes without persistent withdrawal,” wrote corresponding author Stephen A. MD, EdM, FASAM, FAAFP, and coauthors from Boulder Care, Portland, Oregon. “The patient’s comments reflect his brief, successful, and positive initiation experience.”
The rapid, or “QuickStart,” method is significantly faster than other buprenorphine-naloxone initiation protocols that can take days or weeks for a patient to stabilize, leaving patients to choose between severe withdrawal or continued fentanyl use despite overdose risk. QuickStart uses naloxone to accelerate a complete transition to buprenorphine-naloxone in about an hour. As described in the case report, the patient experienced moderately severe symptoms of withdrawal for 14 minutes.
“You will be sick for an hour,” he later reflected, “and then you will be perfectly fine.”
Codeveloped between addiction medicine providers and patients at Boulder Care, the QuickStart method has been replicated across care settings and patients. The process allows flexible timing as to last fentanyl use, provides greater autonomy in starting buprenorphine-naloxone treatment, and aligns with a patient’s readiness to start treatment immediately at home or in a clinical setting, providers explained. The man in the case report completed his buprenorphine-naloxone initiation visit via telehealth while at home with his wife.
“I think patient autonomy over ‘where’ and ‘when’ they begin treatment is one of the most compelling aspects of this new method,” said study coauthor Illana Hull, MD. “Not to mention the predictability it offers to patients in the face of a terrifying and unpredictable drug supply.”
The patient described in the case report remains in care with buprenorphine-naloxone and, according to researchers, is doing well.
“I think [this method] will save a lot of lives,” he said.
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