JAMA Netw Open

Rapid induction improves early retention in buprenorphine treatment

October 16, 2025

Rapid induction is a safe, effective alternative to standard protocols, particularly for patients with high-risk opioid use and fentanyl exposure, improving early retention without increased adverse events. This approach may facilitate broader access and engagement in extended-release buprenorphine treatment, addressing a critical barrier in the current opioid epidemic.

Study details: This multicenter, open-label randomized trial enrolled adults (28 sites, U.S./Canada) with moderate/severe opioid use disorder and high-risk opioid use (frequent use, injection, or fentanyl/analog exposure). Participants were randomized 2:1 to rapid induction (RI: single 4 mg transmucosal buprenorphine, then 300 mg extended-release injection same day) vs. standard induction (SI: ≥7 days of transmucosal buprenorphine before injection). Stratification by urine fentanyl status was performed to address induction challenges in fentanyl users.

Results: At injection 2 (1 week after the first injection), RI was noninferior with an 11.8% higher retention than SI (95% credible interval, 4.3%-19.0%). Among fentanyl-positive participants, the retention rate differential in favor of RI was 14.8%. Adverse event rates were similar between groups, with most events related to opioid withdrawal.

Source:

Shiwach R, et al. (2025, October 1). JAMA Netw Open. Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41085986/