Findings Support Breakthrough Approach in Which Naloxone (Narcan) Enables Full Transition from Fentanyl to Buprenorphine in One Hour
PORTLAND, Oregon., September 29, 2022 /PRNewswire/ — As the United States experiences its worst overdose crisis in history, illegally manufactured fentanyl — a synthetic opioid 50 times more potent than heroin — now largely dominates the drug supply.1 The “age of fentanyl” has created formidable new challenges, both for patients seeking addiction treatment and for the healthcare providers helping them on the front lines.
New findings from researchers at addiction medicine provider Boulder Care offer an important solution, in the form of a compelling clinical innovation called the “QuickStart” method. It relies on naloxone – a commonly used overdose reversal drug – to speed up and ease the patient’s transition off fentanyl when starting drug treatment for addiction.
Using this new approach, individuals can quickly – in 30 minutes or less – begin treatment with buprenorphine-naloxone (BUP-NX) or “Suboxone”, the standard of care for opioid use disorder. (OUD).
BUP-NX is a life-saving treatment, reducing mortality rates by 50% or more. But for people who use fentanyl, transitioning to medication can lead to precipitated withdrawal. Fear of this painful experience drives people to continue using illicit opioids at serious risk of death.
In response to the overdose crisis, public health advocates are urgently calling for new ways to help patients start treatment with BUP-NX.2
Published online September 23 in the Journal of Addiction Medicine, Boulder Peer-Reviewed Case Study features a patient who is completely transitioned to a therapeutic dose of BUP-NX within 3 hours of their last fentanyl use. He did this by self-administering intranasal naloxone, commonly known as Narcan, the overdose reversal drug available at most pharmacies.
Initially, the patient expected and anticipated significant withdrawal. But above all, he only experienced it for about 15 minutes. The “QuickStart” protocol is significantly faster than other BUP-NX initiation methods, which can take days or weeks until a patient is stabilized: often forcing patients to choose between severe withdrawal or continued use of fentanyl, despite continued risk of overdose. With QuickStart, naloxone facilitates a full transition to BUP-NX in about an hour.
According to the patient featured in the study, his advice to others who choose to use this method is, “You’ll be sick for an hour and then you’ll be fine.” The patient stays on BUP-NX and says, “I think [this method] will save many lives.”
The published QuickStart method of using naloxone to accelerate a full transition to BUP-NX has since been replicated in multiple healthcare settings and individuals, co-developed between Boulder’s addiction medication providers and patients. It allows for flexible timing of a person’s last fentanyl use, provides more autonomy in starting BUP-NX, and better aligns with the immediate time a patient expresses a desire to begin treatment at home or in any clinical setting.
dr. Illana Hull, one of the co-authors of the article, explains how valuable this option can be. “I think patient autonomy over ‘where’ and ‘when’ they start treatment is one of the most compelling aspects of this new method,” she says. “Not to mention the predictability it offers patients in the face of a terrifying and unpredictable drug supply.”
Dr Hull continues: “Depending on their preference, patients can make this transition alone, with a peer specialist or other trusted person, or with a clinician. This case also demonstrates the utility of telehealth in supporting patients during initiation of the BUP-NX.”
As another patient reported via Boulder’s secure chat (re-posted here with express permission): “I hope this method gets some attention, it could save a lot of lives. The experience was MUCH easier to handle that a rushed withdrawal and ended much quicker than I thought it would.”
Boulder Care specialists conclude the QuickStart case study with an appeal to the medical community: “In times of crisis – injuries in world wars, burns in mass casualties and the HIV/AIDS epidemic – medical practice has had to respond in seemingly unconventional ways to save lives. Sufferers of OUD are advocating for the same fearless goal to help them start BUP-NX.”
As Boulder Care continues to build on this groundbreaking research, the team looks forward to collaborating with other addiction treatment and harm reduction experts, as well as people who use drugs who can share comments on their lived experience.
For more information on the study or clinical method described, visit: www.boulder.care/quickstart
The authors are currently completing a case series of the new accelerated publishing method.
about the authors
dr. Adam RandallDNP, FNP-C, lead author, is a nurse practitioner at Boulder Care.
Co-author dr. Ilana Hull is a board-eligible family physician in addiction medicine at Boulder Care. She is also an assistant professor in the Department of Medicine at the University University of Pittsburgh Medicine School.
Co-author dr. Stephane Martin is an addiction medicine specialist and medical director of research and education at Boulder Care. He is also a practicing family physician and associate professor of family medicine and community health at UMass Chan Medical School.
About Boulder Care
Boulder Care is a digital clinic that provides telehealth treatment and long-term outpatient recovery services for substance use based on kindness, respect and unconditional support. Dedicated care teams collaborate across medical, behavioral and psychosocial dimensions to provide evidence-based care, including prescription drugs for addiction treatment (MAT), and help patients achieve their recovery goals unique. Millions of people have access to Boulder Care through leading health plans, employers and other partners. For more information, please visit www.boulder.care.
1 O’Donnell J, Tanz LJ, Gladden RM, Davis NL, Bitting J. Trends and patterns in drug overdose deaths involving illicitly manufactured fentanyls – United States2019-2020. MMWR Morb Mortal Wkly Rep. 2021;70(50):1740-1746. doi: 10.15585/mmwr.mm7050e3.
2 Sue, KL, Cohen, S., Tilley, J. & Yocheved, A. (2022). A plea from people who use drugs to clinicians: New ways to initiate buprenorphine are urgently needed in the age of fentanyl. Journal of Addiction Medicine, 16(4), 389–391.
SOURCE Boulder Care