JAMA

Buprenorphine initiation in the ED: Does route of administration matter?

February 12, 2026

In a multicenter randomized trial (NCT04225598) of 1,994 adults presenting to 29 U.S. emergency departments with untreated opioid use disorder, researchers compared a 7‑day extended‑release (ER) injectable buprenorphine regimen with standard sublingual (SL) buprenorphine. Among 1,994 enrolled patients (median age, 37 years; 68% male; 76% fentanyl-positive), treatment engagement at 7 days was similar between groups: 40.5% with ER vs. 38.5% with SL therapy (adjusted difference, 1.6%; 95% confidence interval, −2.8% to 6.0%). Engagement at 30 days was also comparable. Precipitated withdrawal and overdose events were rare in both groups. Patients receiving ER buprenorphine reported lower craving scores, fewer days of illicit opioid use, and higher satisfaction at 7 days.

Clinical takeaway: Both ER and SL buprenorphine were well tolerated and showed similar early treatment engagement, offering clinicians multiple viable ED‑initiation options for patients with opioid use disorder.

Source:

D’Onofrio G, et al. (2026, February 11). JAMA. Emergency Department–Initiated Buprenorphine for Opioid Use Disorder. https://jamanetwork.com/journals/jama/fullarticle/2845042