New Hope for Fentanyl Addiction Treatment

Candra Jordan had been using fentanyl for years while in San Francisco when she finally tried an injection of extended-release buprenorphine. This emerging treatment offered the chance to reduce her cravings for a time. Miraculously, after her session last summer, she managed to visit her son for the first time in six years.

“I’ve tried to quit so many times on my own, and, honestly, nothing ever seemed to work,” Jordan shared about her struggle with addiction. “People probably wouldn’t have believed I could get clean.”

While Narcan is often a lifesaving option for overdose situations, the type of treatment Jordan experienced is instilling hope among healthcare workers and addiction specialists in San Francisco for a more sustained recovery from fentanyl.

This long-acting injectable buprenorphine serves as an “opioid blockade,” attaching to the brain’s receptors and dulling the effects of fentanyl for up to a month. Previously, those seeking to quit had to take daily pills, a challenge for individuals experiencing homelessness or unstable living conditions. The longer-lasting formula increases the likelihood that doctors will be able to check in with patients before cravings return.

However, the medication can trigger temporary withdrawal symptoms that some patients find overwhelming, leading them to abandon treatment altogether. The initial injection lasts just about a week, posing risks of sudden and severe withdrawal if the fentanyl levels in the body aren’t accurately assessed—a tricky endeavor, as many users aren’t certain how much they’ve taken.

Despite these challenges, public health experts and addiction specialists are optimistic that injections represent one of the most promising options in combating the fentanyl crisis. Although overdose deaths in San Francisco have dropped from last year’s peak, they still remain above 600 annually.

In other regions, the use of long-acting buprenorphine is still on the rise or under research. However, San Francisco has been quick to implement it. In January 2024, the city’s Department of Public Health began trials on these injections shortly after one form received FDA approval. In that year, they administered over 1,400 injections throughout the city.

By 2025, the department doubled its usage, providing more than 2,800 injections, which gave numerous people entangled in addiction a pathway to recovery.

This month, the Department of Public Health expanded the medication’s use to jails, enabling incarcerated individuals to receive their first dose within eight hours of arrest.

“It’s empowering for people to use this medication without needing to focus on daily logistics, like keeping track of their dosage,” noted DPH physician Dr. Jeffrey Hom. “This allows them to redirect their focus towards other vital areas of their lives that may have suffered.”

How it Works

As overdose fatalities continue to rise, effective long-term treatments for opioid addiction remain scarce. Fentanyl vaccines are in progress, with at least one moving into initial trials, but approval from the FDA may still be years away. Meanwhile, injectable forms of buprenorphine, marketed under the names Sublocade and Brixadi, are gaining traction globally. Once administered, the drug releases slowly over several days or weeks, helping users avoid the cycle of daily pills.

But there’s definitely a downside.

If not dosed correctly, patients could endure severe, prolonged withdrawal symptoms. Hot flashes, cramps, nausea, and diarrhea can leave individuals feeling helpless and in agony. Even if they’re momentarily shielded from the effects of fentanyl, the discomfort can erode their trust in the treatment.

“It’s like suddenly hitting the brakes on a speeding car,” explained Dr. Christine Soran, deputy medical director of substance use services at DPH. “That abrupt shift is incredibly jarring.”

Rudy Batka, who battled a fentanyl addiction while living on the streets of San Francisco, experienced intense sickness after his first dose of Brixadi, leading him to leave treatment early.

A week later, a physician at a drop-in clinic encouraged Batka, claiming he was in the “ideal window” to receive a second injection that could have kept him fentanyl-free for another month. The doctor assured him this time, he wouldn’t feel sick.

Despite that, Batka hesitated to go forward. Instead, he returned to the streets and quickly relapsed.

Experts acknowledge the complexity of administering the initial dose. Nevertheless, initial studies suggest that these longer-acting injectables may lead to better patient retention than daily alternatives.

A July study found that 43% of incarcerated patients who received their first injection attended a follow-up appointment after release, in contrast to just 29% of those who relied on the daily pill version in custody.

These injections offer patients the freedom to move beyond daily medication hurdles.

“They can leave San Francisco without worrying about running out of pills,” Dr. Hom remarked. “They can travel; reconnect with family. Those are the kind of moments that truly highlight how empowering this can be.”