The FASTER-BUP Study, Extended-Release Injectable Buprenorphine for the Treatment of Opioid Use Disorder Among Individuals at High Risk of Overdose: Protocol for an Observational Prospective Study.

North America is facing an unprecedented public health emergency of opioid-related morbidity and mortality. The mortality benefits of oral medication treatment for opioid use disorder (MOUD), such as methadone or buprenorphine, are well documented. However, barriers to access and long-term engagement have prevented maximizing their benefits. Long-acting injectable buprenorphine formulations were developed to address some of the challenges associated with oral MOUD. The "Pilot study to assess the feasibility, efficacy, and safety of extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose" (FASTER-BUP) was developed to explore this treatment option in populations at high risk of overdose in a real-world Canadian setting. FASTER-BUP is a 24-week observational prospective study evaluating the feasibility and clinical utility of extended-release injectable buprenorphine (XR-BUP) for the treatment of opioid use disorder (OUD) among 40 adults at high risk of overdose (ie, lifetime history of overdose or a positive urine drug test (UDT) for fentanyl within 30 days prior to screening) in Vancouver, BC. The primary outcome is retention in treatment and secondary outcomes include: use of unregulated opioids, safety, overdose events, treatment satisfaction, changes in drug-related problems, changes in quality of life, opioid cravings, health service utilization, and criminal activity. FASTER-BUP is the first study to explore XR-BUP among individuals at high risk of overdose in a real-world Canadian setting. This commentary provides a brief narrative about the study thus far and presents insights on key adaptations to the study protocol, including those adopted to mitigate recruitment challenges.

Hospital-based Buprenorphine/Naloxone Initiation in a Patient With Limited Communication Abilities: A Case Report.

North America's opioid crisis highlights the profound need for low-barrier access to opioid agonist therapy (OAT) for the treatment of opioid use disorder (OUD). This case describes a 33-year-old female with a history of opioid and stimulant use disorder admitted to hospital after a left middle cerebral artery ischemic stroke with resulting aphasia. After medical stabilization, she consented to buprenorphine/naloxone through limited verbal and written communication. After 14 days of titration, she was stabilized on 14 to 3.5 milligrams of buprenorphine/naloxone daily. Buprenorphine/naloxone initiation and titration is patient-based and symptom guided, typically requiring active communication between the patient and care provider. This case illustrates successful buprenorphine/naloxone initiation in a patient with limited receptive and expressive language abilities, emphasizing the feasibility of offering this medication to individuals with limited communication to ensure timely access to evidence-based OUD treatment.