JAMA Article: High-Dose Buprenorphine Is Safe and Effective for Fentanyl-Exposed Population

High-Dose Buprenorphine Initiation in the Emergency Department Among Patients Using Fentanyl and Other Opioids

Roughly 64% of California opioid-involved overdose deaths involved fentanyl. Patients and clinicians have raised concerns that individuals using fentanyl may have suboptimal responses to buprenorphine compared with individuals who use other opioids.

This JAMA Network Open article, written by PHI’s CA Bridge and partners, discusses evidence that supports the use of emergency department (ED) initiated, high-dose Buprenorphine (Bup) for patients in withdrawal from a fentanyl-exposed population. In this cohort study, CA Bridge compared buprenorphine treatment initiation, response and follow-up treatment engagement between patients who did and did not report fentanyl use at CA Bridge EDs.

This data was collected from 16 EDs from across the state, both rural and urban. About 10% of all patients who were administered bup reported known fentanyl use. Of the patients who were administered bup, 89.3% were administered high-dose bup (8-32 mg).

Key Findings:

• 30-day follow-up was similar for those who did and did not report fentanyl use (41.4% vs 37.2%) and higher than those who were not administered bup (23.3%).
• Precipitated withdrawal was rare (1.6%).

This research demonstrates that high-dose bup, initiated in the ED with the CA Bridge model, is safe and effective for patients who use fentanyl.