RESEARCHERS AT BOULDER CARE PUBLISH A NOVEL CLINICAL METHOD TO COMBAT OVERDOSE CRISIS

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 frontlines.

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 disorder (OUD).

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 treatment.² 

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 of lives."

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.

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.

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 www.boulder.care.

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. doi:10.15585/mmwr.mm7050e3.
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, 16(4), 389–391.

SOURCE Boulder Care