Defining Low-threshold Buprenorphine Treatment

TLDR

Buprenorphine treatment is safe and effective, yet only a minority of Americans receive it because many programs impose rigid entry and continuation requirements that limit access. This article defines low‑threshold buprenorphine treatment and proposes guiding principles of same‑day entry, harm‑reduction, flexibility, and wide availability. The authors review evidence supporting these principles and outline directions for future research to refine low‑threshold treatment.

Abstract

Buprenorphine treatment for opioid use disorder is safe and effective, but only a fraction of Americans who need treatment receive it. One reason for this is that many buprenorphine treatment programs have rigid requirements for entry and continuation, limiting the number of people who receive treatment. “Low-threshold treatment” is a term used to describe an alternative approach that attempts to remove as many barriers to treatment as possible. However, few studies have described its essential features. In this article, we define low-threshold treatment and propose the approach be guided by the following principles: same-day treatment entry; harm-reduction approach; flexibility; and wide availability in places where people with opioid use disorder go. We discuss the evidence and rationale for these principles and directions for future research.