Home Initiation of Buprenorphine in Adolescents with Opioid Use Disorder: A Preliminary Feasibility Study

BACKGROUND AND OBJECTIVES: The prevalence of opioid use disorder (OUD) among adolescents has increased, yet few adolescents receive medication for OUD (MOUD), particularly buprenorphine. However, initiation can be challenging, as the medication, a high-affinity partial agonist at the mu opioid receptor, can precipitate withdrawal if administered inappropriately. Many adolescents lack access to appropriate levels of supervised care, making it increasingly important for physicians to feel equipped to initiate buprenorphine at home. This is a preliminary feasibility case series for a protocol used in a pediatric addiction clinic for home initiation of buprenorphine in patients 18 and younger. The primary objective is to outline the protocol used, and the secondary objective is to examine the rate of successful initiation. METHODS: Patients aged 18 years old and younger, who entered treatment for OUD in a child and adolescent outpatient psychiatry clinic between 2022 and 2024 and who chose home buprenorphine initiation were consecutively included. Data from the intake appointment and planned follow-ups at the 1 and 3 month mark were collected. The data collected included characteristics of adolescents who entered treatment and the proportion who successfully initiated buprenorphine. Successful initiation was defined as those who self-reported initiation of buprenorphine at the first follow-up appointment. RESULTS: Out of 19 patients (mean age = 15.7), we found that 10 (53%) adolescents initiated buprenorphine at the first follow-up appointment, 3 (16%) were successful at subsequent follow-up appointments, and 6 (32%) adolescents dropped out of treatment. We also identified several individual and systemic barriers to successful initiation including insurance status, transportation and housing status, and relapse on fentanyl. CONCLUSIONS: This early descriptive study finds that a standard protocol for buprenorphine initiation in adolescents implemented by a trained health care professional in an outpatient setting is preliminarily feasible.