Findings support a groundbreaking approach in
which naloxone (Narcan) enables complete transition from fentanyl
to buprenorphine within one hour
PORTLAND, Ore., Sept. 29,
2022 /PRNewswire/ -- As the U.S. is suffering the
worst overdose crisis in its history, illicitly manufactured
fentanyl – a synthetic opioid 50 times more potent than heroin –
now largely dominates the drug
supply.1 The "Fentanyl Era" has created
formidable new challenges, both for patients seeking addiction
treatment and for care providers helping them on the
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 medication –
to accelerate and ease patient transition off of fentanyl when
starting medication treatment for addiction.
Using this novel approach,individuals can rapidly – in 30
minutes or less – start treatment with buprenorphine-naloxone
(BUP-NX) or "Suboxone," the standard of care for opioid use
BUP-NX is a life-saving therapeutic, 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 causes people to continue illicit opioid use at
grave risk of fatality.
In response to the overdose crisis, public health advocates are
urgently calling for novel ways to assist patients starting BUP-NX
Published online September 23rd in the Journal of
Addiction Medicine, Boulder's peer-reviewed case
study presents a patient who fully transitioned to a
therapeutic dose of BUP-NX less than 3 hours after his last
fentanyl use. He did so by self-administering intranasal naloxone,
commonly known as Narcan, the overdose reversal medication
available in most pharmacies.
Initially, the patient expected and planned for significant
withdrawal. But importantly, he only experienced it for about 15
minutes. The "QuickStart" protocol is significantly faster than
other BUP-NX initiation methods, which can require days or weeks
until a patient is stabilized: often forcing patients to choose
between severe withdrawal or continued fentanyl use, despite
ongoing risk of overdose. With QuickStart, naloxone facilitates the
complete 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 will be sick for an
hour and then you will be perfectly fine." The patient remains in
care with BUP-NX and says, "I think [this method] will save a lot
The published QuickStart method of using naloxone to accelerate
a complete transition to BUP-NX has since been replicated across
multiple care settings and individuals, co-developed between
Boulder's addiction medicine providers and patients. It allows
flexible timing as to a person's last use of fentanyl, provides
more autonomy in starting BUP-NX, and better aligns with the
immediate timing in which a patient expresses readiness to start
treatment at home or in any clinical setting.
Dr. Illana Hull, one of the
paper's co-authors, explains how valuable this option can be. "I
think patient autonomy over 'where' and 'when' they begin treatment
is one of the most compelling aspects of this new method," she
says. "Not to mention the predictability it offers to patients in
the face of a terrifying and unpredictable drug supply."
Dr. Hull continues, "Depending on their preferences, patients
could make this transition on their own, with a peer specialist or
other trusted person, or with a clinician. This case also
demonstrates the utility of telehealth in supporting patients
during BUP-NX initiation."
As another patient reported via Boulder's secure chat (relayed
here with express permission): "I hope this method catches
traction, it could save a lot of lives. The experience was MUCH
easier to handle than precipitated withdrawal and was over much
faster than I thought it would be."
Boulder Care's specialists conclude the QuickStart case study
with a plea to the medical community: "In times of crisis – wounds
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. People suffering from OUD are pleading for the
same intrepid focus to help them begin BUP-NX."
As Boulder Care continues to build upon this groundbreaking
research, the team is eager to collaborate with other experts in
addiction treatment and harm reduction, as well as with people who
use drugs who can share feedback on their lived experience.
For more information about the study or clinical method
described, visit: www.boulder.care/quickstart
Journal of Addiction Medicine Case Report
The authors are currently completing a case series of the new
method for expedited publication.
About the Authors
Dr. Adam Randall, DNP, FNP-C,
lead author, is a Nurse Practitioner with Boulder Care.
Co-author Dr. Ilana Hull is a
family physician, board-eligible in addiction medicine, at Boulder
Care. She is also an Assistant Professor in the Department of
Medicine at the University of
Pittsburgh School of Medicine.
Co-author Dr. Stephen Martin is
an addiction medicine specialist and Medical Director for Research
& Education at Boulder Care. He is also a practicing family
physician and an Associate Professor of Family Medicine and
Community Health at UMass Chan Medical School.
About Boulder Care
Boulder Care is a digital clinic that offers telehealth
treatment and long-term outpatient recovery services for substance
use grounded in kindness, respect, and unconditional support.
Dedicated Care Teams collaborate across medical, behavioral, and
psychosocial dimensions to deliver evidence-based care, including
prescription medications for addiction treatment (MAT), and help
patients work toward their unique recovery goals. Millions of
people have access to Boulder Care through leading health plans,
employers, and other partners. For more information, please visit
1 O'Donnell J, Tanz LJ, Gladden RM,
Davis NL, Bitting J. Trends in and Characteristics of Drug Overdose
Deaths Involving Illicitly Manufactured Fentanyls - United States, 2019-2020. MMWR Morb Mortal
Wkly Rep. 2021;70(50):1740-1746.
2 Sue, K. L., 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 Fentanyl Era. Journal of Addiction Medicine,
SOURCE Boulder Care