# Enhancing buprenorphine low dose initiation (COPILOT)

> **NIH NIH K23** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $197,748

## Abstract

PROJECT SUMMARY/ABSTRACT
Overdose deaths are surging in the United States, mainly due to non-medical fentanyl use. Buprenorphine is a
highly effective medication for opioid use disorder (OUD), reducing overdose deaths and other opioid-related
harms. However, uptake of buprenorphine remains low, in part, due to concerns of precipitated withdrawal
among individuals using fentanyl during traditional buprenorphine initiation. To overcome this barrier, clinicians
have begun using Low Dose Initiation (LDI) protocols. LDI protocols introduce small amounts of buprenorphine
that are gradually increased until a therapeutic dose is reached, minimizing risk for precipitated withdrawal.
The San Francisco Outpatient Buprenorphine Induction Clinic (OBIC) has been offering LDI protocols since
2020. Our preliminary findings note that LDI protocols are now the prevailing strategy to initiate buprenorphine
among patients using fentanyl in San Francisco, though successful completion and retention rates remain low.
Substantial knowledge gaps exist regarding barriers to LDI completion and ideal strategies to enhancing LDI
use. The proposed training and research plan for this K23 application will allow Dr. Leslie Suen to acquire the
skills necessary to achieve her career goal of becoming an NIH-funded independent clinician investigator with
expertise in implementation science and developing interventions to improve treatment outcomes for
individuals with OUD. With the guidance of her dedicated mentoring team and rigorous training plan, Dr. Suen
will apply advanced skills in intervention development, mixed methods, and randomized trial design and
evaluation to develop and pilot an Enhanced LDI program. Enhanced LDI will leverage implementation science
frameworks to test various behavioral interventions to increase successful buprenorphine initiation and
retention. Building on Dr. Suen’s prior research in OUD treatment outcomes and LDI use, this proposal
addresses the following aims: 1) identify challenges and barriers to LDI completion using in-depth interviews
with patients, clinicians, and system leaders; 2) design an Enhanced LDI program using focus groups of
patients, practitioners, pharmacists, and other healthcare staff to test strategies for improving buprenorphine
uptake; 3) evaluate the preliminary impact of the Enhanced LDI program on successful initiation and retention
through a 6-month pilot randomized controlled trial (RCT) with patients with OUD using fentanyl, comparing
Enhanced and Usual LDI treatments. The evaluation will use various data sources to assess successful
initiation, acceptability, and feasibility. This proposal has the goal of improving and developing novel
interventions for OUD treatment in real-world settings, and it aligns with Dr. Suen’s career development plan to
gain expertise in intervention development, mixed methods, and randomized trial and evaluation. The findings
of this proposal will lead to an R01 application to test Enhanced ...

## Key facts

- **NIH application ID:** 10864837
- **Project number:** 1K23DA060329-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Leslie W. Suen
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $197,748
- **Award type:** 1
- **Project period:** 2024-08-01 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10864837

## Citation

> US National Institutes of Health, RePORTER application 10864837, Enhancing buprenorphine low dose initiation (COPILOT) (1K23DA060329-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10864837. Licensed CC0.

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