Episode Rewind | Transition to Extended-release Buprenorphine Injectable Within Seven Days for Opioid Use Disorder Treatment: A Scoping Narrative

Episode Rewind | Transition to Extended-release Buprenorphine Injectable Within Seven Days for Opioid Use Disorder Treatment: A Scoping Narrative

What insights can experts and survivors share about addiction? This episode of *Addiction Medicine: Beyond the Abstract* brings you a clinical deep dive into opioid use disorder treatment with clinician–scientist Dr Pouya Azar. Across the conversation, you'll hear Dr Azar unpack his narrative review on transitioning patients from traditional buprenorphine to extended-release and long-acting injectable formulations within seven days or even 24 hours.

He explains why this matters in an era where, as he bluntly puts it, "we're working in a void of evidence right now" because most existing protocols were built around heroin, not high-potency synthetic opioids like fentanyl. Dr Azar shares striking stories from early in his career in Vancouver, including realising just how quickly fentanyl changed the landscape and how "the tolerances that we're seeing in our patients are staggering".

From there, you’ll get a clear explanation of why standard buprenorphine inductions can fail for people using fentanyl, how precipitated withdrawal differs from simple opioid deficiency, and why meeting opioid requirements during low-dose induction is crucial. The episode also compares monthly versus seven-day injectable buprenorphine, looking at practical pros and cons: fewer visits and longer protection versus shorter commitments and more frequent contact.

Dr Azar is frank about the need for high-quality trials, saying current guidance leans heavily on case reports and open-label studies. For clinicians or students eyeing a career in addiction medicine, the closing section is especially relevant. His advice? "Do what fascinates you, do what you love," and make room for creativity rather than only memorising guidelines. He urges future doctors to ask, "Is there another way of doing it?" and to consider research that solves real clinical problems.

If you're curious about how evidence, pharmacology, and clinical reality intersect in modern opioid treatment, this conversation might prompt you to rethink how care could look in the fentanyl era.