Evolving Buprenorphine Initiation Strategies: Direct to Inject
Presenter: Andrea Truncali, MD and Kristen Silvia, MD
In the era of high-potency fentanyl, clinicians prescribing medications for opioid use disorder (MOUD) face increasing challenges when initiating buprenorphine treatment. Traditional induction approaches, including standard-dose, high-dose, and low-dose protocols, all have limitations, and concerns about precipitated withdrawal often make patients hesitant to begin treatment. In recent years, both prospective and retrospective studies have described the use of injectable buprenorphine for treatment initiation, an approach known as “direct-to-inject” (DTI). The weekly injectable formulation, with its slower onset of action, may help reduce the risk of precipitated withdrawal. In this presentation, we will review the latest published evidence on DTI, share our clinical experience using this approach, and discuss practical considerations and implementation challenges.
Learning objectives:
By the end of this presentation, participants will be able to:
- Describe the pharmacokinetic properties of injectable buprenorphine that support its use as an effective initiation option.
- Explain the complexities and potential differences between provider and patient understandings of precipitated withdrawal.
- Evaluate the current evidence supporting direct-to-inject (DTI) approaches to buprenorphine initiation.
- Identify patient characteristics and clinical factors that may make DTI a reasonable initiation option.
Audience:
Prescribing Clinicians and their teams
Continuing Medical Education:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Hanley Center for Health Leadership and Education and CCSME. The Hanley Center for Health Leadership and Education is accredited by the Maine Medical Association Committee on Continuing Medical Education and Accreditation to provide continuing medical education for physicians.
The Hanley Center for Health Leadership and Education designates this regularly scheduled series for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
*Nurses and Nurse Practitioners will be awarded a certificate of participation with a maximum of 1 AMA PRA Category 1 Credit ™.
This course has been approved by Co-Occurring Collaborative Serving Maine (CCSME), as a NAADAC Approved Education Provider, for 1 educational credits. NAADAC Provider #324712, CCSME is responsible for all aspects of the programming.
Contact Hours 1 contact hours for social workers, licensed clinical professional counselors, and behavioral health professionals.
1 Category 1 Contact hours for psychologists. CCSME is a pre-approved sponsor and provider of Professional Education Activities for Psychologists.
1 contract hours CHES. CCSME is a designated provider of continuing education contact hours (CECH) in health education by the National Commission of Health Education Credentialing, Inc.
Speakers
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Andrea Truncali MD MPHMD, MPHAndrea Truncali, MD, MPH is a board-certified physician in both Internal and Addiction Medicine, and an Assistant Professor of Medicine at Tufts University. She completed medical school and residency at New York University, followed by further training in preventive medicine and public health. In pursuit of improving the health and well-being of underserved people, Dr Truncali takes care of patients in specialty substance use treatment as well as primary care settings, provides education and guidance to physicians on the topic of substance use disorder, and contributes to activities at the state level regarding substance use prevention and treatment.
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Kristen B Silvia MDMDAfter spending ten years as a family physician, my career is now focused on providing quality care to people dealing with substance use disorders. Like many other chronic illnesses, substance use disorders can be challenging to treat and require the development of a therapeutic doctor-patient relationship. Helping someone enter into long term recovery from addiction has been one of the most rewarding parts of my career.
