Evidence map›Paper›PMID 41610958›Full record

ArticleJournal of substance use and addiction treatment2026

"It's like scratching at the door": Experiences of outpatient buprenorphine low dose initiation among people using fentanyl.

Leslie W Suen, Elyssa Samayoa, Matthew A Spinelli, Maia Scarpetta, Kelly R Knight, Julia Chael, Christine S Soran, Michelle Geier, Hannah R Snyder, Phillip O Coffin

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of substance use and addiction treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Qualitative study of blister pack use during buprenorphine low dose initiation.Journal of the American Pharmacists Association : JAPhA
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Leslie W SuenDivision of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: Leslie.suen@ucsf.edu.
Elyssa SamayoaDivision of Substance Abuse and Addiction Medicine, Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
Matthew A SpinelliDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Maia ScarpettaDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Kelly R KnightDepartment of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA.
Julia ChaelDepartment of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Christine S SoranSan Francisco Department of Public Health, San Francisco, CA, USA.
Michelle GeierSan Francisco Department of Public Health, San Francisco, CA, USA.
Hannah R SnyderDepartment of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA.
Phillip O CoffinDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA.

Funding

Enhancing buprenorphine low dose initiation (COPILOT)K23DA060329 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Leslie W. Suen · 2024 to 2026
$593k
NIDA NIH HHS K23 DA060329
6 · The paper itself

Abstract

backgroundThe fentanyl-driven overdose crisis has heightened challenges in buprenorphine initiation, as traditional methods risk precipitated withdrawal due to fentanyl's prolonged presence in the body. Buprenorphine low-dose initiation (LDI) offers a gradual approach to starting buprenorphine but requires continued full-agonist opioid use in outpatient settings, where success rates remain low and patient experiences have not been evaluated.

objectivesTo identify barriers and facilitators to successful LDI completion and inform strategies to improve outpatient buprenorphine treatment.

methodsWe conducted 19 semi-structured interviews with people with opioid use disorder using fentanyl who had attempted LDI in the past three months. Using the COM-B framework, we applied thematic analysis to identify barriers and facilitators to LDI completion from interviews until reaching thematic saturation.

resultsWe found that barriers and facilitators to LDI completion were linked to five COM-B model components: physical capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. Despite high desirability and acceptability among participants towards starting LDI, several main barriers to LDI completion emerged, including difficulty tolerating "waves" of discomfort throughout LDI, anticipatory anxiety of precipitated withdrawal with each buprenorphine dose, lack of symptomatic response from small buprenorphine doses, loss of "high" from fentanyl, readily available fentanyl access leading to temptations to use, unstable or triggering housing environments, and being around others using fentanyl. Facilitators for completing LDI included increased optimism for success, the appeal of gradual recovery, bubble-packing medications, use of prescribed and non-prescribed drugs, supportive personal relationships, and non-stigmatizing clinic and pharmacy environments.

conclusionsOur study applied a novel behavior-change framework to understanding barriers and facilitators to LDI completion. Barriers aligned closely with the COM-B model, providing a foundation for developing future interventions to enhance buprenorphine uptake and acceptability among people with OUD using fentanyl. Addressing barriers to automatic motivation is likely to have the largest benefit, with interventions such as incentivization (e.g., gift cards for completing LDI), environmental restructuring (e.g., temporary housing or comfort spaces for LDI), behavior modeling (e.g., peer coaches), and enablement (e.g., 24/7 phone lines for patients to call) most directly addressing this barrier category.

Indexed as

BuprenorphineFentanylNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersAdultAmbulatory CareAnalgesics, OpioidFemaleHumansMaleMiddle AgedMotivationOutpatientsSubstance Withdrawal SyndromeAnalgesics, OpioidBuprenorphineFentanylNarcotic AntagonistsBuprenorphineFentanylLow dose inductionOpioid use disorderPrecipitated withdrawalSubstance use disorder treatment

Identifiers

PMID41610958
PMCPMC13274478

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.