“You’re Hoping for the Best, but Preparing for the Worst”: Discussions of Starting Buprenorphine in the Context of Fentanyl Use with Clinicians and People Who Use Fentanyl - Report - MDSpire
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“You’re Hoping for the Best, but Preparing for the Worst”: Discussions of Starting Buprenorphine in the Context of Fentanyl Use with Clinicians and People Who Use Fentanyl
Clinical Report: Conversations on Initiating Buprenorphine for Fentanyl Users
Overview
Revise to include specific anxieties of clinicians and patients regarding precipitated withdrawal.
Background
Opioid use disorder (OUD) remains a significant public health crisis, with approximately 60,000 opioid-related deaths in the USA in 2024. Despite the availability of effective treatments like buprenorphine, only 25% of individuals with OUD receive these medications. The rise of fentanyl in the drug supply complicates treatment initiation due to concerns about precipitated withdrawal, necessitating a better understanding of clinician and patient experiences.
Data Highlights
No numerical data or trial data was provided in the article.
Key Findings
Buprenorphine is effective for treating OUD but initiation poses challenges, especially with fentanyl use.
Clinician barriers include stigma, lack of knowledge, and low confidence in prescribing buprenorphine.
Patients express heightened anxiety about starting buprenorphine due to fears of precipitated withdrawal.
Illicit fentanyl's high potency and lipophilicity increase the risk of precipitated withdrawal when initiating buprenorphine.
There is a lack of qualitative literature on the real-world experiences of clinicians and patients regarding buprenorphine initiation.
Clinical Implications
Clinicians should be aware of the specific anxieties patients may have about starting buprenorphine, particularly in the context of fentanyl use. Enhanced communication and education strategies are essential to address these concerns and improve treatment initiation rates.
Conclusion
Understanding the experiences of both clinicians and patients is crucial for developing best practices in buprenorphine initiation. Addressing the barriers identified can help close the treatment gap for individuals with opioid use disorder.
