Buprenorphine Initiation in the Era of High-potency Synthetic Opioids: A Call for Community-based Participatory Research to Help Learning Health Systems Provide Precision Medicine for Opioid Use Disorder
David A. Fiellin
Abstract
High-potency synthetic opioids and adulterants have saturated the US opioid supply, heightening risk to people who use drugs and creating challenges to buprenorphine initiation. As buprenorphine is an essential component of a response to the opioid crisis, a robust evidence base is urgently needed. Rapid research, in partnership with people who use drugs and using community-based participatory research practices to ensure trust, shared goals, and an absence of adverse consequences, should be conducted to help identify the factors associated with successful and failed inductions. Among factors to be considered include detailed assessment of substances used, amount of substances used, time between last use and buprenorphine induction, withdrawal severity at time of buprenorphine induction, dose of buprenorphine, impact of buprenorphine on withdrawal severity, and perhaps even genotypic information. Successful conduct of these efforts in learning health systems can help us move toward precision medicine for opioid use disorder.