A large cohort study found a clear dose response relationship between higher early buprenorphine dosing and reduced mortality. Patients receiving more than 16 mg daily in the first month had substantially lower overdose and all cause death rates compared to lower dose groups.

Two large cohort studies compared retention and ongoing opioid use among patients receiving methadone versus buprenorphine. Methadone showed slightly higher retention, while both medications reduced illicit opioid use effectively. Choosing between them remains a patient centered clinical decision.

Long-acting injectable formulations of buprenorphine can be a good treatment option for patients with opioid use disorder, particularly for those with poor adherence. However, starting long-acting injectable medications typically requires the patient to be on a stable dose of sublingual buprenorphine. Here, researchers demonstrate the feasibility of starting buprenorphine with a microinduction approach followed shortly by administration of a long-acting injection.

Buprenorphine induction typically requires that a patient experience moderate opioid withdrawal before starting the medication in order to avoid precipitating severe withdrawal symptoms. This waiting period is uncomfortable and can be a treatment barrier. In this study, researchers develop and test an induction protocol using injectable buprenorphine that gets around this initial waiting period.

Injectable naltrexone can be an effective treatment for opioid use disorder, but it requires complete abstinence before initiation—a process that can take more than a week and cause significant discomfort. Here, researchers evaluate a new protocol designed to accelerate this induction period and improve patient access.

Buprenorphine is a first-line treatment for opioid use disorder, however, given buprenorphine to a patient who still has opioids in their system can precipitate severe withdrawal. Careful assessment of withdrawal can minimize the risk, but despite our best efforts, precipitated withdrawal can still occur. In this article, we review what to do for our patients experiencing buprenorphine-precipitated opioid withdrawal.

Long-acting buprenorphine is a promising new treatment for opioid use disorder, but it usually requires a seven-day stabilization period before initiation. Here, researchers develop and evaluate a novel protocol for initiating long-acting injectable buprenorphine in a single day. The trial is small, but results are promising.