Medications for Opioid Use Disorder: Patients' Experience, Knowledge, and Preferences in the Era of Illicitly Manufactured Fentanyl.

Background: Illicitly manufactured fentanyl (IMF) presence has increased reports of buprenorphine precipitated withdrawal and may impact medication for opioid use disorder (MOUD) experiences and preferences.

Methods: Cross-sectional survey administered by a clinical research coordinator of adults treated by an addiction consult team or bridge clinic who had prior experience with MOUD.

Results: Among 100 respondents surveyed, 36% identified as female, 11% black, 9% Hispanic, 79% white, 29% had stable housing, 93% used fentanyl, and 65% injected commonly. 51% were currently treated with methadone, 41% were currently treated with sublingual buprenorphine, 12% were currently treated with extended-release buprenorphine, and 1% were currently treated with extended-release naltrexone. Most reported their current MOUD managed withdrawal and cravings well; 83.7% for methadone, 70.4% for sublingual buprenorphine, and 91.7% for extended-release buprenorphine. 75.8% of participants who tried buprenorphine reported ever experiencing precipitated withdrawal. Even so, 43.1% of those not being treated with buprenorphine were willing to start. Two-thirds reported cravings or withdrawal had worsened since IMF and 55% said IMF impacted MOUD decision making; however, 59% did not feel more worried about taking MOUD since IMF. Most (86%) had heard about low-dose buprenorphine initiation, 52.3% of those who had heard of it had tried it, and 57.8% reported positive experiences. 40% had heard of high-dose buprenorphine, 60% of those tried it, and 54.2% had positive experiences. The factors most likely to increase participants' willingness to start MOUD were immediate access (85%), rapid titration (87%), hearing positive things from friends (82%), and getting MOUD from their doctor (63%).

Conclusions: Despite IMF impacting withdrawal, cravings, and MOUD decision making, most patients felt MOUD managed symptoms well. Experiences with alternative buprenorphine initiations were positive. Access to low-barrier treatment with immediate medication initiation, aggressive dose escalation, office-based treatment, and peer-based messaging around MOUD may increase treatment uptake.