Buprenorphine-hesitancy as a sequela of buprenorphine-precipitated withdrawal among syringe service program clients

Buprenorphine is a medication for opioid use disorder (OUD) known to reduce OUD-related mortality. Buprenorphine may precipitate opioid withdrawal if administered too soon after another opioid. Prior studies have found divergent results as to whether buprenorphine-precipitated withdrawal is a barrier to OUD treatment, necessitating further inquiry. To assess buprenorphine-precipitated withdrawal among syringe service program clients with active OUD and determine if history of buprenorphine-precipitated withdrawal was associated with hesitancy to try buprenorphine again. One hundred forty-eight ( n = 148, male = 92, female = 54) syringe service program clients with OUD were consecutively recruited for a cross-sectional survey. Participants were asked about buprenorphine-precipitated withdrawal, and hesitancy to try buprenorphine again. Descriptive analyses, a Mann-Whitney U test, and a Spearman’s ρ partial correlation controlling for age, sex, and race were conducted. One hundred participants ( n = 100) − 84% of those who had tried buprenorphine - reported buprenorphine-precipitated withdrawal. Participants who used fentanyl reported greater buprenorphine-precipitated withdrawal than participants who used other opioids [fentanyl Mdn = 4 (very severe), other opioid Mdn = 3 (severe)], U = 419.5, z = − 2.987, p = 0.003. Participants who had buprenorphine-precipitated withdrawal expressed greater reluctance to try buprenorphine again [Yes Mdn = 4 (agree), No Mdn = 2 (disagree)], U = 516.5, z = − 2.649, p = 0.008. Buprenorphine-precipitated withdrawal severity was associated with buprenorphine hesitancy (rs (89) = 0.430, P < 0.001). Buprenorphine-precipitated withdrawal is a preventable adverse drug reaction associated with reluctance to try buprenorphine again.