SynthesisAddiction science & clinical practice2021
Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review.
Synthesis in Addiction science & clinical practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: an updated systematic review.Addiction science & clinical practice · 2025Pooled it
- Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis.Addiction science & clinical practice · 2022Pooled it
- Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review.Pharmacotherapy · 2022Pooled it
- Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal.JAMA network open · 2024Trial
- "It's like scratching at the door": Experiences of outpatient buprenorphine low dose initiation among people using fentanyl.Journal of substance use and addiction treatment · 2026Article
- Outpatient Initiation of 7-Day Injectable Buprenorphine: A Direct-to-Inject Case Series.Substance use & addiction journal · 2025Article
- Perspectives on medication for opioid use disorder (MOUD) access and service delivery among a community sample of people who use opioids in Los Angeles.Journal of substance use and addiction treatment · 2025Article
- Challenges in Transitioning from Methadone to Buprenorphine-Naloxone for Chronic Pain Management: Two Cases.Psychopharmacology bulletin · 2025Article
- Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl.JAMA network open · 2025Article
- Low-Dose Buprenorphine Initiation for Hospitalized Patients With Chronic Pain and Opioid Use Disorder or Opioid Misuse: Protocol for an Open-Label, Parallel-Group, Effectiveness-Implementation Randomized Controlled Trial.Substance use & addiction journal · 2025Article
- Buprenorphine use among non-hospital residential programs.Drug and alcohol dependence · 2024Article
- Navigating Buprenorphine Therapy: A Closer Look at Microdosing vs. Macrodosing for Pain Management and Opioid Addiction - A Narrative Review.Addiction & health · 2024Review
- Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study.Journal of substance use and addiction treatment · 2024Article
- Overview of best practices for buprenorphine initiation in the emergency department.International journal of emergency medicine · 2024Article
- A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder.Drugs in R&D · 2023Review
- Trajectories of non-prescribed buprenorphine and other opioid use: A multi-trajectory latent class growth analysis.Journal of substance use and addiction treatment · 2023Article
- "They say it's fentanyl, but they honestly look like Perc 30s": Initiation and use of counterfeit fentanyl pills.Harm reduction journal · 2022Article
- Enhancing Patient Choice: Using Self-administered Intranasal Naloxone for Novel Rapid Buprenorphine Initiation.Journal of addiction medicineArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOpioid withdrawal symptoms prior to buprenorphine initiation may be intolerable and as a result, alternative strategies have emerged. We aim to systematically review the efficacy and safety of buprenorphine initiation that aims to omit prerequisite withdrawal.
methodsWe conducted a systematic literature search of MEDLINE and CENTRAL from 1996 through April 10, 2020, augmented with searches in Google Scholar and www.clinicaltrials.gov . A study was included if it was in patients with substance use disorder or chronic pain that were taking a full mu opioid agonist and transitioning to buprenorphine without preceding withdrawal, and reported withdrawal during initiation as an outcome. Two investigators independently screened citations and articles for inclusion, collected data using a standardized data collection tool, and assessed study risk of bias.
resultsWe included 15 case reports/series, reporting 24 unique cases, in our qualitative synthesis. No controlled studies were identified. Microdosing and bridging with a buprenorphine patch were the most common strategies reported. Transition to buprenorphine with complete cessation of opioid agonists was achieved in 87.5% (n = 21) of cases. Withdrawal during initiation occurred in 58.3% (n = 14) of cases, two of which were at least moderate in severity.
conclusionBuprenorphine initiation strategies that omit prerequisite withdrawal have emerged. Low quality evidence from case reports suggests withdrawal during initiation is common but most often mild in severity. There is an unmet need for controlled studies to inform their efficacy and safety compared with traditional strategies, including outcomes during initiation and in the long-term.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.