A Novel Method of Buprenorphine Induction Utilizing Buprenorphine extended-released Subcutaneous injection, intranasal naloxone and sublingual buprenorphine: A case report
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Publication Date
2025
Abstract
Background: Current buprenorphine induction protocols were developed to treat heroin and prescription opioid use disorder. When applied to fentanyl, they are often unsuccessful. A new method for inducing buprenorphine called QuickStart involves simultaneous administration of intranasal naloxone and sublingual buprenorphine, with the ensuing withdrawal symptoms treated with additional sublingual buprenorphine. Administering buprenorphine extended-release subcutaneous injection (Sublocade) prior to QuickStart induction has not been detailed in medical literature. Objective: To describe a novel buprenorphine induction method utilizing Sublocade, intranasal naloxone and sublingual buprenorphine in a patient with fentanyl use disorder. Methods: Information was obtained by electronic medical record review, participation in the buprenorphine induction, interviews with the patient, and literature review. The patient read and signed an informed consent form, was provided a manuscript, and authorized publication. Results: A 22-year-old woman with fentanyl use disorder was induced on buprenorphine in our family medicine clinic with a combination of Sublocade, intranasal naloxone and sublingual buprenorphine. She experienced the expected precipitated withdrawal which peaked at thirty minutes and resolved at two hours. Reassessment at two months post-induction showed no return to fentanyl use and the patient has received regular administrations of Sublocade. Conclusion: Presented is the case of a patient who was treated in an ambulatory family medicine clinic for fentanyl use disorder with a novel buprenorphine induction method utilizing Sublocade followed by simultaneous administration of naloxone and sublingual buprenorphine. She has not returned to fentanyl use. This buprenorphine induction method may benefit patients unable to tolerate current buprenorphine induction methods and increases short-term buprenorphine compliance.
Specialty/Research Institute
Graduate Medical Education
