QuickStart | Boulder
A new option for people with OUD
Introducing QuickStart: a naloxone-accelerated complete transition method for starting buprenorphine
Watch our QuickStart webinar
On March 2nd, 2023 we hosted a webinar to share what we know about QuickStart so far — and invited questions from the community. Watch the recording below, and you can download the slides here. Please get in touch if you have questions, experiences to share or are interested in partnering with us.
Boulder QuickStart: a community-informed, novel approach to starting buprenorphine (recording)
The saturation of illicitly manufactured fentanyl in the U.S. drug supply has made it more challenging for people with opioid use disorder to start treatment on buprenorphine (most commonly prescribed as BUP-NX, or Suboxone), because the methods we used to use to help people start on buprenorphine are now more likely to cause painful precipitated withdrawal. This has led to an urgent call for new methods that can be individualized to each person’s unique case.
Most common alternative methods for BUP initiation focus on reducing a patient’s risk of precipitated withdrawal — but to do so, they extend the time the transition takes to complete, therefore prolonging exposure to fentanyl’s harms.
Buprenorphine Initiation Methods
Long transition periods and the fear of unpredictable withdrawal can deter people from seeking BUP treatment and cause return to use. QuickStart offers a groundbreaking, new, and much quicker alternative.
Read the case report in Journal of Addiction Medicine
A New Option
Initiating medication treatment with QuickStart
QuickStart is a new method for initiating buprenorphine-naloxone (BUP-NX), also known as Suboxone. It uses naloxone (commonly known as Narcan) to clear opioid receptors at the start of your transition from fentanyl. This eliminates the need to wait after your last use of opioids, and means you can start a full dose of BUP-NX right away, without tapering. You can prepare for a short, controlled withdrawal period that lasts only minutes, and your clinician may help prescribe medications that make symptoms more comfortable. QuickStart is intended for patients with recent use of opioids who are not yet experiencing significant withdrawal symptoms.
You can expect the full QuickStart process to take less than an hour.
No required waiting since last use
Starting the moment you're ready avoids the need for severe, uncertain, and prolonged withdrawal. Waiting periods are fraught with the risk of returning to use and exposure to the lethality of fentanyl.
No tapering
You can take a full dose of buprenorphine right off the bat. No need to follow a complicated tapering schedule, or continue to use fentanyl during your transition. Stop when you want, right away.
Faster, by a lot
The full process is so fast, it’s measured in minutes, not days. So far, all of our patients have completed the process and felt good enough to sleep within an hour.
Short, predictable, and managed withdrawal
Yes, you will experience moderate withdrawal. But it is very short — minutes — and under your control. As soon as you start to feel symptoms, you take a full-dose of BUP-NX, which acts quickly to ease them.
Naloxone-accelerated
This method is unique in that it relies on naloxone — not to reverse an overdose, but to clear your receptors instantly so the full dose of BUP-NX can be introduced.
Patient autonomy
You decide when and where you’re ready. You don't need to go to a clinic, and you're able to self-administer and control the entire process in a very short period of time.
Ready for QuickStart?
If you're interested in trying QuickStart for yourself, we're here to help. See if you're eligible to enroll with Boulder.
Hear from patients who've done it.
“Used nasal spray naloxone at 9:30. At 9:45 begin taking 24 mg of Suboxone. By 10:00 felt significantly better. Thank you... I hope this method catches traction, could save a lot of lives. The experience was MUCH easier to handle than precipitated withdrawal and was over much faster than I thought it would be”
— Boulder Patient
“Highly recommended. You will be sick for an hour and then you will be perfectly fine…I think [this] will save a lot of lives.”
— Boulder Patient
“I just wanted to update you on how it went. I took the suboxone at about 10 minutes after taking my naloxone...After the buprenorphine dissolved and kicked in I ended up sleeping all night as well and woke up feeling fine.”
— Boulder Patient
How QuickStart works
The QuickStart method starts with administering naloxone (an opioid antagonist, aka Narcan). Naloxone clears the opioids in your system, including fentanyl, from the brain’s opioid receptors. This will also start withdrawal symptoms. As soon as those symptoms begin, you'll quickly start on a full dose of BUP-NX (partial opioid agonist, aka Suboxone) to cover the newly cleared opioid receptors.
The BUP-NX limits and ends your withdrawal quickly while it also protects your receptors from any remaining fentanyl (or other full opioid agonists) in your system. Your brain and body adjust to this new, stable dose of BUP-NX. You don’t need to taper your opioid use ahead of time or after, and you don't need to slowly increase your buprenorphine dose after to get to a stable dosage level.
What to expect
The QuickStart method is an emerging science, and like any method, experiences will vary from person to person. But according to patients who have tried QuickStart, you can expect 30 minutes of moderate withdrawal symptoms, and a total time of about 1 hour for the entire process. Most patients are ready for a nap after about 30 minutes, and wake up feeling symptom free and stable.
Because QuickStart is certain to induce withdrawal for a short period, this method requires that patients are able and willing to tolerate more significant withdrawal symptoms than is expected in other methods, even if that withdrawal lasts for less time. For this reason, particular caution should be used in counseling patients with underlying cardiac disease or unstable psychiatric conditions. Some patients will feel the temporary discomfort is worth the speed at which the transition can be completed while others will not.
Why now?
In times of crisis — wounds in World Wars, burns in mass casualties, and the HIV/AIDS epidemic — the medical community has had to respond in seemingly unconventional ways to save lives. People suffering from OUD are pleading for the same intrepid focus to help them begin BUP-NX.
“Rapid research, in partnership with people who use drugs and using community-based participatory research practices to ensure trust, shared goals, and an absence of adverse consequences, should be conducted to help identify the factors associated with successful and failed inductions.” – Fiellin, David A. MD
"With the worst opioid overdose death crisis in the United States history, urgent new approaches to assist people who use drugs onto medication for opioid use disorder are necessary. People who use drugs should be involved at all levels with ongoing research, clinical and policy efforts to improve buprenorphine initiation as their lives and their suffering are at stake." **–_** Kimberly L Sue et al
Frequently asked questions
How established is the QuickStart clinical method?
We believe it is essential to share promising evidence as soon as it is available for the benefit of the research and public health community in our collective efforts to keep people who use drugs safe. While a handful of case studies represents a small sample size, this method has been replicated and thus far successful in all known cases. Boulder’s clinical and research teams include leading experts in the field of addiction medicine. This effort is being led by:
- Dr. Adam Randall, DNP, FNP-C, Nurse Practitioner with Boulder Care.
- Dr. Ilana Hull, a family physician, board-eligible in addiction medicine, at Boulder Care. She is also an Assistant Professor in the Department of Medicine at the University of Pittsburgh School of Medicine.
- Dr. Stephen Martin is an addiction medicine specialist and Medical Director for Research & Education at Boulder Care. He is also a practicing family physician and an Associate Professor of Family Medicine and Community Health at UMass Chan Medical School.
Our findings were presented at the California Society of Addiction Medicine in August and in a peer-reviewed case-report published in the Journal of Addiction Medicine on Sept 23rd. Ongoing research has been preliminarily accepted for additional publications.
Why didn't people do this before?
This is an innovation that came from direct work and co-development with our patients, as we believe all healthcare interventions should. A patient gave themselves Narcan while on a telehealth visit with their Boulder clinician, supported by a loved one in the room with them. The clinician instructed the patient to take a full-dose of BUP-NX as intended, as the patient was starting to feel withdrawal symptoms. After a few minutes, it became clear that the withdrawal was subsiding and the patient was stabilizing. They felt good enough that they asked to take a nap (with a loved one nearby to monitor them), and woke up feeling refreshed.
Having since walked a number of patients through similar processes, we have observed no added medical risk to the transition. QuickStart simply uses proven, safe medications in a new order and with new protocols, to a different, and potentially very beneficial, end.
How do I do QuickStart with Boulder?
The fastest way to get started is to check your eligibility and enroll with Boulder. We’ll walk you through it and answer your questions!
How does QuickStart compare to other methods?
Other induction methods take much, much longer with required waiting periods since last use, tapering schedules, and micro-dosing schedules. (The average transition takes 8 days and can last even longer.) QuickStart is a complete transition lasting under an hour. After the transition, you'll be on a stable dose of buprenorphine and can continue working toward your recovery goals.
Will this work for everyone?
Just as other initiation methods do not work for every patient, the QuickStart method will not be ideal for all patients—or even for the same patient in different circumstances. Each patient is unique with experiences and values that shape their priorities. Our duty, as in all areas of medicine, is to listen to our patients, explain risks and benefits of all treatment options, and then engage in shared decision-making. While it is imperative that we invest resources in larger trials to learn more about alternative BUP initiation methods, our patients are dying and cannot wait. We must be bold in our efforts to return autonomy to patients who have already lost so much to the lethality of fentanyl.
Is there a summary of the initial case report?
Yes! Follow the link below for our summary page and an option to download a summary handout.