Case series: Symptom-inhibited fentanyl induction (SIFI) onto treatment-dose opioid agonist therapy in a community setting.

Abstract

Background and objectives: Existing opioid agonist therapy (OAT) guidelines are far from sufficient to address rising opioid tolerances and potency of the unregulated opioid market in North America. Inadequate starting doses of OAT are a universally recognized barrier for people who use fentanyl. Our objectives are to present a novel induction protocol called symptom-inhibiting fentanyl induction (SIFI) that uses rapid intravenous fentanyl administration to inhibit symptoms of opioid withdrawal.

Methods: We describe two cases highlighting the potential clinical utility of SIFI.

Results: This case series demonstrates two safe and successful transitions onto higher-than-standard doses of methadone and slow-release oral morphine harnessing an emerging approach of SIFI in a community clinic setting.

Discussion and conclusions: These results support emerging evidence that SIFI is safe and feasible to meet patients' opioid requirements and facilitate rotation onto OAT. Further studies are needed to increase the generalizability of these findings.

Scientific significance: Safe transitions onto treatment-dose OAT are of heightened clinical importance at a time when fentanyl and high-potency synthetic opioids are now the norm. SIFI is a novel induction method that could address significant gaps in the currently available OAT options in the fentanyl era.