From Induction to Injection: Rethinking Buprenorphine Starts

As fentanyl reshapes opioid use disorder treatment, long-standing buprenorphine induction practices are being challenged. In this episode, we examine emerging evidence supporting rapid, same-day initiation of long-acting injectable buprenorphine, alongside the growing role of high-dose transmucosal buprenorphine for fentanyl use disorder. We discuss why traditional multi-day inductions may increase dropout without improving safety—and how rapid initiation can improve early retention, including among patients actively using fentanyl. We also explore when and why higher buprenorphine doses may be necessary to adequately suppress withdrawal and cravings in the fentanyl era. We cover common misconceptions about precipitated withdrawal, and key contraindications and protocol caveats. Designed for addiction fellows and frontline clinicians, this episode emphasizes a shift from withdrawal-centric rituals to retention-focused care—getting effective treatment started when it matters most. Hosted by Paula Donnelly Cook, MD and Darlene Petersen, MD. Check us out on facebook @Theaddictionfiles or twitter @THEADDICTIONFI1 or Instagram Theaddictionfiles or email us at [email protected] No explicit language but this podcast discusses the abuse and treatment of legal and illegal drugs and may not be appropriate for all listeners. Disclaimer: Content of this website and podcast are for entertainment and educational purposes only. Hosts and guests are not responsible for any harm caused by information obtained from these sources. As each person is unique you are advised to seek the advice of your own healthcare professional to treat any medical conditions you may be having. Opinions expressed on this show are those of The Addiction Files and not of our respective employers.