PSHP 2026 Residency Conference

Purpose: To assess the feasibility and benefits of low dose buprenorphine induction (LDBI) for opioid use disorder (OUD) management in patients using illicit fentanyl compared with standard buprenorphine induction.
Methods: A single-center, retrospective cohort study was conducted at St. Mary Medical Center between August 1, 2024-December 1, 2025. Included patients reported fentanyl use and were inducted on buprenorphine for OUD treatment during hospitalization. The primary outcome was successful completion of buprenorphine induction defined as receiving at least 8 mg/day of buprenorphine and Clinical Opiate Withdrawal Score maintained at less than or equal to 12 from protocol start to completion or reported, subjective low levels of withdrawal. Secondary outcomes included length of stay (LOS), induction duration, clinical pharmacy specialist (CPS) consult, buprenorphine prescription on discharge and within 30 days, and switch to alternative therapy. The safety outcomes were naloxone administration, precipitated withdrawal occurrence, and rapid response events. 
Results: Sixteen patients in the standard induction arm and 18 patients in the LDBI arm were enrolled.  More patients in the LDBI arm successfully completed induction compared with standard (9 [50%] vs. 3 [19%], p =0.08). CPS was consulted in 100% of successful low dose inductions. The odds of precipitated withdrawal were significantly higher among patients receiving standard induction compared to LDBI (OR 5.7, 95% CI 1.31-25.05) and 19% of standard induction patients had a rapid response event attributed to precipitated withdrawal. The LDBI group had a longer LOS of 6.8 days compared with 2.6 days in the standard group, but had less patient directed discharges and more buprenorphine prescriptions on discharge and within 30 days. 
Conclusion: LDBI was found to be associated with a higher rate of successful inpatient buprenorphine inductions compared with standard induction. LDBI had significantly lower odds of precipitated withdrawal and patients were more likely to follow up based on a higher incidence of discharge scripts. LDBI provides a feasible and well-tolerated alternative to standard induction for inpatient illicit fentanyl withdrawal management. 
IRB Approval: Approved