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January 25, 2025 – A new study led by doctors at the University of California, San Francisco (UCSF), has tested an experimental approach aimed at helping individuals struggling with fentanyl addiction. This study, published in JAMA Network Open, explores a strategy known as low-dose initiation of buprenorphine – a medication used to treat opioid use disorder.
During the COVID-19 pandemic, fentanyl overdoses surged, and doctors were desperate to find ways to help patients battling opioid addiction. Buprenorphine had already shown promise as a treatment for opioid dependence, but it posed a unique challenge for those using fentanyl, which stays in the body longer than other opioids. The problem? Administering buprenorphine too soon, while fentanyl is still active in the system, can induce severe withdrawal symptoms.
To address this, a new strategy was devised – administering small doses of buprenorphine over several days to gradually increase the dosage, allowing the body to adjust without triggering severe withdrawal.
However, the results of the UCSF study, involving 126 participants treated between May 2021 and November 2022, were disappointing. Only 34% of participants were able to work up to a full dose of buprenorphine using this low-dose initiation method. Furthermore, a small percentage of individuals – just 22% – remained on the medication for at least 28 days.
Leslie W. Suen, MD, MAS, the study’s first author, expressed disappointment with the findings but emphasized the importance of sharing the results. “This doesn’t seem like it’s working the way we had hoped,” said Dr. Suen, an addiction medicine specialist at UCSF. “But when people expect it to work, and it doesn’t work for them, they feel like there’s something wrong with them.”
The research aimed to overcome the barriers to buprenorphine initiation, particularly with fentanyl users, whose bodies store the drug longer, making withdrawal more unpredictable. Prior to fentanyl’s rise in popularity, buprenorphine had a higher success rate in opioid treatment, as the drug’s initiation was more straightforward with substances like heroin, which leave the body more predictably. Fentanyl, however, has complicated this process, and doctors had hoped that the low-dose approach would ease the transition to buprenorphine.
In the study, patients participated in either a seven-day or a four-day low-dose regimen. Participants who followed the four-day regimen had a 38% success rate, while the seven-day protocol yielded a 28% success rate. Overall, just 34% of participants were able to successfully initiate buprenorphine therapy.
Despite the low success rate, Dr. Suen remains optimistic, noting that the findings suggest a need for more effective treatment strategies for individuals trying to quit fentanyl. “We are already working on a follow-up study to understand why this approach didn’t work as well as we had hoped,” Dr. Suen added.
Buprenorphine, one of three FDA-approved medications for treating opioid use disorder, has been effective in helping many patients overcome addiction. However, the drug is often underused due to limited access, insurance complications, and social stigma. As fentanyl use continues to rise, there is an urgent need for effective solutions to address this public health crisis.
Disclaimer: This article is based on the study published in JAMA Network Open and does not serve as medical advice. Please consult a healthcare professional for personalized treatment recommendations.
