New Study in JAMA Network Highlights DESC’s Innovative Approach to Starting Lifesaving Opioid Use Disorder Medication Among People Using Fentanyl 

Press Advisory — August 15, 2025

New Study in JAMA Network Highlights DESC’s Innovative Approach to Starting Lifesaving Opioid Use Disorder Medication Among People Using Fentanyl 

SEATTLE, WA – A new study published today in JAMA Network Open finds that a novel “injectable-only overlapping” buprenorphine starting protocol developed and implemented by DESC shows promising results for people with opioid use disorder (OUD) who are using fentanyl — particularly those experiencing homelessness or living in permanent supportive housing. 

In the study, 75% of participants completed the three-day injection series, and 64% continued treatment with a second monthly dose — outcomes that are significantly higher than rates reported for other outpatient initiation methods. The protocol allows patients to begin buprenorphine treatment without first stopping fentanyl use, removing a major barrier that can prevent people from starting this evidence-based medication for OUD. 

“Buprenorphine, as with methadone, is an essential element of the treatment plan for those with opioid use disorder,” said Dr. Richard Waters, DESC medical director and clinical instructor of family medicine at the University of Washington School of Medicine. “Fentanyl has complicated things, making starting buprenorphine trickier, which led our team to look for potentially easier ways to start this lifesaving medication. Our results suggest that this method — using a sequence of long-acting buprenorphine injections that go under the skin — may be a promising alternative for people who have struggled to start buprenorphine in other ways.” 

The research took place within DESC’s Opioid Treatment Network, a low-threshold outpatient program that delivers care both in clinic and directly in the field — meeting patients where they are, including in shelters, supportive housing buildings, and encampments. Nearly 80% of study participants were experiencing homelessness or living in DESC permanent supportive housing. 

“Being able to get someone started on life-saving medication like buprenorphine without the need for an initial period of withdrawal is particularly important for people experiencing homelessness,” said Dr. Jared Klein, associate professor of medicine at the University of Washington School of Medicine and senior author of the paper. “This study is a significant contribution to the existing literature around novel methods of starting buprenorphine in the era of fentanyl.”  

This approach reflects DESC’s continuum of care model, which combines permanent supportive housing with comprehensive behavioral and medical health services to address the root causes of chronic homelessness. For more than 45 years, DESC has pioneered evidence-based solutions, including Housing First, to ensure people have stable housing and the wraparound supports they need for recovery and stability. 

“Medication alone is not enough,” said DESC Executive Director Daniel Malone. “People are more likely to succeed when they have housing, behavioral health care, and other robust supports in place. This study shows how integrated care models — linking treatment to housing and outreach — can help people overcome barriers to starting and staying on lifesaving medication.” 

The full article, Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting, is available online at: Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting | Clinical Pharmacy and Pharmacology | JAMA Network Open | JAMA Network 

NOTE: DESC’s Opioid Treatment Network (OTN) will soon be rebranded as the “Patient Outreach Division” (POD) — a mobile care team that provides medications for opioid use disorder (MOUD) as part of our new Opioid Recovery & Care Access (ORCA) Center at 517 Third Ave. Learn more about the ORCA Center at desc.org/orca-center. 

👉 Read more about our innovative approach to opioid use disorder and how it’s changing outcomes for people addicted to fentanyl in this April 2025 Seattle Times article: https://www.seattletimes.com/seattle-news/homeless/seattle-nonprofit-rolling-out-potential-game-changer-for-fentanyl-addiction/ 

Contributing authors/researchers: Richard C. Waters, MD, MSc; Jeremy Hoog, MA, RN, BSN; Carson Bell, MPH; Penelope Toland, RN, BSN; Joseph Valley, MPH, RN; Lupe Hurtado, CPC, AAC; Mary Ann Kallisen, RN; Tashay Johnson, AAC; April Gerard, RN, BSN, PMH-BC; Callan Elswick Fockele, MD, MS; Jared W. Klein, MD, MPH. 

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About DESC 
The Downtown Emergency Service Center (preferred name DESC) works to end chronic homelessness in Seattle and King County by combining permanent supportive housing with health care and other services. DESC’s continuum of care includes street outreach, low-barrier shelters, crisis response, behavioral and medical health services, and nearly 2,000 units of permanent supportive housing. For more information, visit www.desc.org.