“It's like scratching at the door”: Experiences of outpatient buprenorphine low dose initiation among people using fentanyl

Our study applied a novel behavior-change framework to understanding barriers and facilitators to LDI completion. Barriers aligned closely with the COM-B model, providing a foundation for developing future interventions to enhance buprenorphine uptake and acceptability among people with OUD using fentanyl. Addressing barriers to automatic motivation is likely to have the largest benefit, with interventions such as incentivization (e.g., gift cards for completing LDI), environmental restructuring (e.g., temporary housing or comfort spaces for LDI), behavior modeling (e.g., peer coaches), and enablement (e.g., 24/7 phone lines for patients to call) most directly addressing this barrier category.