{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T20:06:30Z","timestamp":1774641990529,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Addict"],"published-print":{"date-parts":[[2025,5]]},"abstract":"Abstract<\/jats:title>Background and Objectives<\/jats:title>Existing opioid agonist therapy (OAT) guidelines are far from sufficient to address rising opioid tolerances and potency of the unregulated opioid market in North America. Inadequate starting doses of OAT are a universally recognized barrier for people who use fentanyl. Our objectives are to present a novel induction protocol called symptom\u2010inhibiting fentanyl induction (SIFI) that uses rapid intravenous fentanyl administration to inhibit symptoms of opioid withdrawal.<\/jats:p><\/jats:sec>Methods<\/jats:title>We describe two cases highlighting the potential clinical utility of SIFI.<\/jats:p><\/jats:sec>Results<\/jats:title>This case series demonstrates two safe and successful transitions onto higher\u2010than\u2010standard doses of methadone and slow\u2010release oral morphine harnessing an emerging approach of SIFI in a community clinic setting.<\/jats:p><\/jats:sec>Discussion and Conclusions<\/jats:title>These results support emerging evidence that SIFI is safe and feasible to meet patients' opioid requirements and facilitate rotation onto OAT. Further studies are needed to increase the generalizability of these findings.<\/jats:p><\/jats:sec>Scientific Significance<\/jats:title>Safe transitions onto treatment\u2010dose OAT are of heightened clinical importance at a time when fentanyl and high\u2010potency synthetic opioids are now the norm. SIFI is a novel induction method that could address significant gaps in the currently available OAT options in the fentanyl era.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajad.70011","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T04:58:32Z","timestamp":1739941112000},"page":"355-360","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Case series: Symptom\u2010inhibited fentanyl induction (SIFI) onto treatment\u2010dose opioid agonist therapy in a community setting"],"prefix":"10.1111","volume":"34","author":[{"given":"Pouya","family":"Azar","sequence":"first","affiliation":[{"name":"Integrated Psychiatry, Pain, and Addiction Service Vancouver General Hospital Vancouver British Columbia Canada"},{"name":"Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7473-1617","authenticated-orcid":false,"given":"Jane J.","family":"Kim","sequence":"additional","affiliation":[{"name":"Integrated Psychiatry, Pain, and Addiction Service Vancouver General Hospital Vancouver British Columbia Canada"},{"name":"Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Davison","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoran","family":"Barazanci","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha J.","family":"Ignaszewski","sequence":"additional","affiliation":[{"name":"Integrated Psychiatry, Pain, and Addiction Service Vancouver General Hospital Vancouver British Columbia Canada"},{"name":"Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"},{"name":"Substance Use Response and Facilitation Service, BC Children's Hospital Provincial Health Services Authority British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S. H.","family":"Wong","sequence":"additional","affiliation":[{"name":"Integrated Psychiatry, Pain, and Addiction Service Vancouver General Hospital Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Machado","sequence":"additional","affiliation":[{"name":"Integrated Psychiatry, Pain, and Addiction Service Vancouver General Hospital Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Harris","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver British Columbia Canada"},{"name":"Department of Family Practice, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Krausz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nickie","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada"},{"name":"BC Mental Health & Substance Use Services, Provincial Health Services Authority British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Herring","sequence":"additional","affiliation":[{"name":"Bridge, Public Health Institute Oakland California USA"},{"name":"Department of Emergency Medicine Highland General Hospital\u2013Alameda Health System Oakland California USA"},{"name":"Department of Emergency Medicine University of California The C4 Foundation San Francisco United States USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio S. 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