“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

Category	Detail
Condition	Opioid Use Disorder (OUD)
Key Mechanisms	Buprenorphine is a partial opioid agonist that displaces other opioids, which can lead to precipitated withdrawal if not timed correctly.
Target Population	Individuals using fentanyl and experiencing opioid use disorder.
Care Setting	Outpatient clinics, including primary care and psychiatry.

Approximately 60,000 opioid-related deaths in the USA in 2024.
Only 25% of individuals with OUD in the USA are receiving medication treatments.
Fentanyl's high potency and lipophilicity increase the risk of precipitated withdrawal when initiating buprenorphine.
Clinician barriers include stigma, lack of knowledge, and low confidence in prescribing buprenorphine.
There is a need for qualitative insights from clinicians and patients to improve buprenorphine initiation practices.

Initiate buprenorphine after a sufficient waiting period to avoid precipitated withdrawal.

Increased risk of precipitated withdrawal when transitioning from fentanyl to buprenorphine.

Individuals using fentanyl with opioid use disorder.

Effective communication and education are crucial for both patients and clinicians regarding buprenorphine initiation.

Educate patients about the risks of precipitated withdrawal.
Utilize a patient-centered approach to address fears and concerns about treatment.
Implement flexible buprenorphine initiation protocols tailored to individual patient needs.

Clinical Scorecard: Balancing Optimism and Caution: Conversations on Initiating Buprenorphine for Individuals Using Fentanyl with Healthcare Providers