High-Dose Buprenorphine Treatment in the Setting of Fentanyl

Several recent studies provided a range of prevalence rates (1%-16%) for PW with buprenorphine initiation for persons with OUD using fentanyl, which may reflect differences in study design and setting. While certain studies described rates of PW that were 3 to 4 times higher among those with fentanyl use compared with those without, they were limited by low power due to the small number of PW events. Studies also did not provide clear evidence as to whether higher buprenorphine initiation is associated with lower risk of PW. Studies suggest higher retention and lower health care utilization with high dose vs the standard approach; however, there were methodologic problems due to observational study design, such as immortal time bias and unmeasured confounding. Evidence to inform clinicians’ decisions whether to initiate buprenorphine treatment with high-dose strategies among patients who use fentanyl was limited, and more definitive studies are needed.

Corresponding Author: Judith I. Tsui, MD, MPH, Division of General Internal Medicine, Department of Medicine, University of Washington, 325 Ninth Ave, Seattle, WA 98122 (tsuij@uw.edu).

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