Objective:

To explore the barriers and facilitators experienced by patients and clinicians related to initiating buprenorphine in the context of fentanyl use, highlighting the urgent need to address the treatment gap.

Key Findings:

• Clinicians face barriers such as stigma, lack of knowledge, and low confidence in prescribing buprenorphine, which can hinder treatment access.
• Patients express anxiety about precipitated withdrawal when starting buprenorphine after fentanyl use, indicating a need for better support.
• There is a lack of qualitative literature on real-world experiences of clinicians and patients regarding buprenorphine initiation, underscoring the need for further research.

Interpretation:

The study highlights the need for improved communication and education around buprenorphine initiation, particularly in the context of fentanyl use, to alleviate clinician and patient anxieties and improve treatment outcomes.

Limitations:

• The study's sample may not be representative of all clinicians and PWUF, which could limit the generalizability of the findings.
• Findings are based on qualitative data, which may not be generalizable; further quantitative studies are needed to validate these insights.

Conclusion:

Addressing the barriers and concerns identified in this study can help improve buprenorphine initiation practices and ultimately reduce the treatment gap for opioid use disorder, which remains a critical public health issue.