At-home buprenorphine initiation could improve access for adolescents - Children's National

A recent study led by Sivabalaji Kaliamurthy, MD, director of the Addictions Program at Children's National Hospital, revealed that adolescents diagnosed with opioid use disorder (OUD) can successfully start buprenorphine treatment at home within one week.

Published in the Journal of Child and Adolescent Psychopharmacology, the study also found that some patients who did not initiate at-home treatment within the first week were able to do so at later follow-up attempts.

"Adolescents face significant barriers to accessing medications for OUD," said Dr. Kaliamurthy, lead author of the study. "Our results suggest that supported at-home buprenorphine initiation may offer a safe, feasible and accessible pathway to treatment."

The big picture

The study evaluated 19 patients aged 18 years and younger between 2022 and 2024 who had a diagnosis of moderate or severe OUD. A clinic physician provided education on at-home buprenorphine initiation, including instructions for use and discussion of associated risks. Adolescents were instructed to begin buprenorphine when they reached their maximum tolerance for withdrawal symptoms or when their subjective opioid withdrawal scale (SOWS) score exceeded 17.

On day 1, participants initiated treatment with 2/0.5 mg buprenorphine/naloxone, with one repeat dose after 30 minutes, followed by additional 2/0.5 mg doses every 2 hours as needed, up to a maximum dose of 8/2 mg. On day 2, participants began with the total dose taken on day 1, followed by 2/0.5 mg every 2 hours as needed based on subjective cravings, up to a maximum daily dose of 16 mg. On day 3, participants were instructed to continue taking the total dose reached on day 2 through their 1-week follow-up appointment with the physician. Supportive medications were also given to take as needed.

By the 1-week follow-up, 10 of the 19 adolescents had successfully initiated treatment at home. An additional 3 adolescents were later successful in initiating treatment at home at a later date. Six participants did not continue.

The hold up in the field

This is the first study to evaluate at-home buprenorphine initiation in adolescents 18 years and under. Researchers also identified several barriers to successful treatment initiation, including insurance coverage, transportation and housing instability and relapse. At the same time, the authors noted that multiple aspects of the protocol likely contributed to successful at-home initiation, including bilingual materials, SOWS-guided timing and anticipatory guidance to reduce discomfort or misuse, such as avoiding smoking or vaping before dosing.

Children's National leads the way

The Addictions Program at Children's National is one of the only pediatric substance use disorder programs in the region and continues to advance treatment options for children and adolescents with addiction. Dr. Kaliamurthy and colleagues have led multiple studies focused on youth and opioid use disorder, helping build evidence for innovative approaches to care. Read more about their related research:

What's next

While larger studies are needed to confirm efficacy and define best practices, the authors say the findings offer early support for more accessible treatment models, including home initiation.

"This work highlights an important shift toward models that expand access and meet youth where they are, especially when higher levels of care are not available," said Dr. Kaliamurthy.

Additional authors from Children's National include - Emma Straton, BA.

Read the study, Home Initiation of Buprenorphine in Adolescents with Opioid Use Disorder: A Preliminary Feasibility Study, in the Journal of Child and Adolescent Psychopharmacology.