High-dose buprenorphine induction in the emergency department for treatment of opioid use disorder.

Question: Is high-dose (>12 mg) buprenorphine induction safe and well tolerated in patients with untreated opioid use disorder who present to the emergency department? Findings: In this case series of 579 cases, 54 clinicians followed a high-dose buprenorphine (monoproduct) protocol. There were no documented episodes of respiratory depression or excessive sedation, and precipitated withdrawal was rare (0.8% of cases) and was not associated with dosing. Meaning: These findings suggest that high-dose buprenorphine induction, adopted by multiple clinicians in a single-site, urban emergency department, was safe and well tolerated in patients with untreated opioid use disorder