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Buprenorphine extended-release (BUP-XR) provides sustained delivery of buprenorphine to control withdrawal and craving symptoms in the formof a monthly injectable and has been shown to improve health outcomes in patients with opioid use disorder. It is recommended that patients are stabilized with a transmucosal buprenorphine product, for at least 7 days per the product monograph; however, clinically, this timelinemay be expedited. We report a case of a hospitalized patient with unregulated fentanyl use who underwent a successful transdermal buprenorphine induction for 48 hours to initiate BUP-XR with minimal levels of withdrawal and without precipitating opioid withdrawal. The approach described could provide a practical, patient-centered, accelerated induction strategy that, once independently validated, could considerably facilitate the use of BUP-XR. [ABSTRACT FROM AUTHOR]

Buprenorphine is an effective medication for the treatment of opioid use disorder. However, the traditional method of buprenorphine induction requires a period of abstinence and the development of at least moderate withdrawal, which can be barriers in starting treatment. We present the case of a hospitalized patient with opioid use disorder using unregulated fentanyl, who underwent a transdermal buprenorphine induction over 48 hours to initiate sublingual buprenorphine/naloxone on the third day. The patient experienced minimal levels of withdrawal and did not experience precipitated withdrawal. The ease of use of this novel induction method over previously published induction protocols can greatly improve the accessibility of buprenorphine for patients and healthcare staff. [ABSTRACT FROM AUTHOR]

Aim: First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high‐risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods: A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high‐risk opioid use among youth. After full‐text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results: Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost‐effectiveness for opioid agonist treatment than abstinence‐based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions: From the limited findings, there is no evidence to deny youth with high‐risk opioid use the same treatment options available to adults. A combination of pharmacological and youth‐specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals. [ABSTRACT FROM AUTHOR]

Purpose – Psychiatry and other areas of mental healthcare have a limited reach. According to the National Comorbidity Survey in the USA the majority of people with mental illnesses do not get any professional support. The current “acute care focus” treatment paradigm directs funding toward hospitals, medications and institutions. The purpose of this paper is to explore the appropriateness of this approach. Design/methodology/approach – To assess the acute care focus in mental healthcare, the authors will contrast it with an alternative paradigm of harm reduction. Findings – The authors argue that harm reduction principles based on the experiences of addiction medicine may be an added value to the current system of care along with structural reforms regarding early intervention and community-focussed care. Originality/value – This discussion paper contributes to a growing body of literature recognizing the inefficiencies of the present acute care centered paradigm in healthcare. [ABSTRACT FROM AUTHOR]

Buprenorphine is an effective treatment for opioid use disorder but can be slow when using a standard low-dose titration protocol to avoid precipitated withdrawal. This presents a substantial practical barrier in clinical practice. Recent low-dose induction strategies have attempted to simplify and shorten the process required for successful induction, including our own transdermal buprenorphine method, which achieves induction to sublingual buprenorphine/naloxone after 48 h. Here, we present two inpatients with active unregulated fentanyl use that were successfully initiated on buprenorphine extended-release with a novel 24-h transdermal buprenorphine protocol without precipitating withdrawal. This protocol may represent a substantial improvement in the practical feasibility of initiating buprenorphine for patients and providers, although further study is required to confirm efficacy and tolerability. [ABSTRACT FROM AUTHOR]