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In an effort to combat the fentanyl crisis, doctors have experimented with a microdosing technique to help patients transition to buprenorphine, a medication proven to aid in opioid recovery. However, a significant study conducted by researchers at UC San Francisco has raised concerns about the effectiveness of this method. Despite the initial hope for success, the approach yielded lower-than-expected results, prompting calls for further exploration and improved treatment strategies.
Doctors Seek Solutions Amid the Fentanyl Crisis
As fentanyl overdoses surged during the COVID-19 pandemic, healthcare providers faced an urgent need to develop new treatment strategies for those struggling with opioid use disorder. Buprenorphine, a well-known treatment for opioid addiction, is usually effective for many patients. However, for those using fentanyl, initiating buprenorphine therapy can be more challenging. Fentanyl stays in the body longer than other opioids, and introducing buprenorphine too soon can trigger intense withdrawal symptoms.
To address this issue, doctors began experimenting with a microdosing method—gradually administering small doses of buprenorphine over several days. The goal was to allow the body to adjust to the medication slowly, preventing severe withdrawal while still transitioning the patient onto the recovery drug.
The Study and its Disappointing Results
In a recent study published in JAMA Network Open on January 24, 2025, researchers evaluated the success of this low-dose buprenorphine initiation method. The study, led by Dr. Leslie W. Suen and her colleagues at UCSF, followed 126 participants and found that only 34% successfully transitioned to the full buprenorphine dose using this microdosing approach. Dr. Suen, an addiction medicine specialist at UCSF, expressed disappointment in the findings but emphasized the importance of sharing these results.
“This doesn’t seem like it’s working the way we had hoped,” Dr. Suen said. “When people expect it to work, and it doesn’t work for them, they feel like there’s something wrong with them.”
The study examined two protocols: one with a seven-day regimen of low-dose buprenorphine and another with a four-day protocol. The success rate varied, with 38% of participants on the four-day regimen successfully starting full-dose buprenorphine, while only 28% succeeded on the seven-day protocol. In total, only 22% of participants stayed on the medication for at least 28 days. Repeated attempts to initiate buprenorphine after initial failure showed even lower success rates.
Buprenorphine: A Partial Solution with Barriers
While buprenorphine is a widely used medication for opioid use disorder, its success has been limited by several factors, including a lack of physicians trained to prescribe it, insurance challenges, and societal stigma. As a partial opioid agonist, buprenorphine alleviates withdrawal symptoms and cravings without producing the intense euphoria of stronger opioids, making it a vital tool in opioid recovery.
Before the widespread availability of fentanyl, the initiation of buprenorphine had higher success rates. However, fentanyl’s long-lasting presence in the body has made it more difficult for patients to begin buprenorphine treatment without experiencing precipitated withdrawal. Doctors hoped that microdosing could minimize discomfort, but the new study suggests that the method may not be as effective as anticipated.
A Call for New Approaches
Despite the disappointing results of this study, Dr. Suen and her colleagues remain committed to finding better solutions for fentanyl users. The researchers are already involved in a follow-up study to further understand why the microdosing approach has not worked as effectively as hoped.
“We need more options for helping people start buprenorphine treatment,” Dr. Suen said. “This approach may not be the answer, but it opens the door to more innovative ideas and strategies.”
As the fentanyl crisis continues, it is clear that the road to recovery remains complex, and finding effective treatment methods for those affected is more urgent than ever.
Disclaimer: The information presented in this article is based on a recent study published in JAMA Network Open. The findings are specific to the study and do not represent general treatment protocols for all individuals with opioid use disorder. Always consult with a healthcare provider for personalized medical advice.
