Leslie Suen, MD, MAS

Public health efforts are rightly focused on reducing opioid overdose deaths. We know relatively little about severe morbidity among overdose survivors. Our new paper in @journalgim.bsky.social provides the first national estimates of overdose-related hypoxic-ischemic brain injury

rdcu.be/ezNUN

Climate disasters create life-threatening disruptions for people on methadone The U.S.’s reliance on methadone clinics is not just an inconvenience — it is anathema to a world grappling with escalating climate disasters.

See @suenlw.bsky.social, Rachel Luba, and my Op Ed in @statnews.com on the impact of #climatechange on #methadone and the importance of modernizing the OTP system. www.statnews.com/2025/07/23/m...

People often ask me--what the hell does a SOTA do? A lot actually, especially when it comes to deciding state treatment programs for opioid use disorder! Come to this webinar and learn all you ever wanted to know about SOTAs

Graphic of workshop facilitators for Bugs, Drugs, and Harm Reduction: Skills for Optimizing Antibiotic Therapy in People Who Use Drugs

Congratulations to the AMERSA 2024 Best Workshop Award winner! This award, based on participant reviews, is presented each year to an outstanding workshop delivered at the annual conference. @ayeshaappamd.bsky.social @kinnathakarar.bsky.social @madelinemc5.bsky.social @katelcsw.bsky.social

Sad to be missing #ASAM but I was shocked to see our paper on low dose buprenorphine initiations named as one of the most impactful papers of the year! It’s an honor and I’m grateful to our amazing team that made this happen 🤩

1. Today the NIH director issued a new directive slashing overhead rates to 15%.

I want to provide some context on what that means and why it matters.

grants.nih.gov/grants/guide...

RFK Jr. endorses medications for opioid addiction at confirmation hearing, but misleads on 12-step programs During his Thursday Senate confirmation hearing, RFK Jr. shed light for the first time on his attitudes toward medication-assisted treatment for opioid addiction.

RFK says he supports methadone and buprenorphine — but majorly misrepresents a study that he claimed shows 12-step programs are more effective vs. opioid addiction

(The study was exclusively about alcohol!)

www.statnews.com/2025/01/30/r...

In Spring 2024, we sent trained auditors into all 125 pharmacies in Austin, Texas to find OTC naloxone & attempt to purchase a 10-pack of syringes. Proud to contribute to this study led by @thesudpharmd.bsky.social w/support from a team of dedicated pharmacy students. jamanetwork.com/journals/jam...

Everyone concerned about data loss right now should learn about the End of Term Web Archive, which I believe has been working on preserving federal websites for the past 8 months. The dataset you fear has been lost may well be here

Just an incredible project. Thank you to everyone involved

CDC's Youth Risk Behavior Survey (YRBS) -- which, since 1990, has tracked high school students' behaviors that can influence health and social outcomes (like smoking, drug use, and dietary habits) -- is now offline

Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl This cohort study assesses rates of successful buprenorphine initiation and retention among adults who use fentanyl receiving a low-dose buprenorphine initiation protocol in the outpatient setting to ...

During the pandemic, doctors tried microdosing buprenorphine to help fentanyl users avoid withdrawal and start treatment. A UC San Francisco study found this low-dose approach worked only 34% of the time, with most patients unable to reach a full dose despite gradual increases over several days.

And as always, none of this work would be possible without our fantastic clinicians, researchers, and health systems leaders at San Francisco Dept of Public Health and @ucsfhealth.bsky.social

Our study was also featured in the SF Chronicle: www.sfchronicle.com/sf/article/u...

Low-Dose Initiations of Buprenorphine in the Fentanyl Era As fentanyl has become dominant in the US drug supply, clinicians and patients have sought alternative strategies for buprenorphine initiation to avoid precipitated withdrawal. Limited evidence on the...

Please be sure to also check out this wonderful invited commentary on the study by Justin Berk, Michael Rose, and Ashish Thakrar, contextualizing how this study fits in the larger field: jamanetwork.com/journals/jam...

What’s next?

More research is urgently needed to:
1) Refine LDI protocols and understand where/how people are tripping up during LDI
2) Develop tailored strategies to better support people using fentanyl

What does this mean for our communities?

This study underscores how difficult it is to start and stay on buprenorphine for people using fentanyl. Despite LDI’s potential, barriers remain—only ~1 in 5 patients stayed on treatment for 28 days.

Notably, people trying repeated LDI attempts had lower odds of success.

So if patients aren’t successful the first time around, they should be counseled that repeated attempts may yield even lower rates of success and maybe consider alternative strategies to starting bup or consider methadone.

Key results:
What did we find?
1) In 34% of attempts, patients successfully started buprenorphine.
2) No significant differences between protocols in overall success or retention. Successful initiation: 38% (4-day LDI) vs. 28% (7-day LDI). Retention at 28 days: 21% (4-day LDI) vs. 18% (7-day LDI)

Key outcomes we looked at:
1) Successful initiation: Completing the LDI and picking up a maintenance prescription.
2) Retention: Staying on buprenorphine for at least 28 days.

Doctors Test a New Way to Help People Quit Fentanyl During COVID-19, researchers found that low-dose buprenorphine initiation for fentanyl users was largely unsuccessful, with repeated attempts also failing.

What did we do?

Our study analyzed electronic health records for 126 patients using fentanyl who attempted buprenorphine LDI at two San Francisco clinics between May 2021 and Nov 2022. We compared two protocols: a 4-day vs. 7-day LDI regimen.

www.ucsf.edu/news/2025/01...

Why does this matter?

Fentanyl’s high potency makes starting buprenorphine—key to treating OUD—challenging due to the risk of precipitated withdrawal. LDI is a promising strategy, but no prior studies have compared outcomes between different protocols.

Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl This cohort study assesses rates of successful buprenorphine initiation and retention among adults who use fentanyl receiving a low-dose buprenorphine initiation protocol in the outpatient setting to ...

Excited to share findings from our recent study on #opioiduse disorder (#OUD) treatment! We looked at two buprenorphine low-dose initiation (LDI) protocols for people using fentanyl. 🧵👇 jamanetwork.com/journals/jam...

It’s time scientists leave the ivory tower and explain exactly why their research is important for the general public. We need people to understand the societal implications if science is gutted.

National Institute of General Medical Sciences NIGMS supports basic research to understand biological processes and lay the foundation for advances in disease diagnosis, treatment, and prevention.

The NIH diversity supplement pages have all been pulled down. What is a diversity supplement and why should the public care? A diversity supplement is funding to help diversify the research workforce. You may be wondering, “so what?”. Let me explain. www.nigms.nih.gov/Pages/PageNo...

Association of safer smoking supply distribution with participant encounters and naloxone distribution from syringe services programs: Findings from the National Survey of Syringe Services Programs in... In response to the recent and growing shift from injecting heroin to smoking fentanyl, an increasing number of syringe services programs (SSPs) in the…

Our new study found 44% of syringe services programs (SSPs) distributed safer smoking supplies in 2022. SSPs distributing supplies had more participant encounters and naloxone distribution. Safer smoking supplies are a key tool to connect people who use drugs to life-saving services.

Bottom line: Prescription psychostimulants hold promise for treating StUD. With proper monitoring and comprehensive care, they can be a safe, legal, and effective tool in fighting this growing crisis of stimulant-related toxicity deaths.

Despite challenges, federal & state authorities must clarify laws, reduce stigma, & promote evidence-based practices. Professional orgs, researchers, & clinicians can help by publishing recommendations, sharing case studies, & training clinicians to affirm this as regular treatment.

Clinicians fear legal risks. However, a 2022 Supreme Court ruling (Ruan v. U.S.) raised the bar for prosecuting prescribers, requiring proof of INTENTIONAL misconduct. Legitimate, well-documented prescribing is highly defensible under federal law.

Though clinicians should still note STATE laws.

Evidence is promising but mixed:
- Psychostimulants may help reduce self-reported stimulant use, cravings, and depressive symptoms.
- A 2022 meta-analysis found benefits on urine drug tests, esp. with higher doses of methylphenidate.
- More research is needed.

Recent guidelines by the American Society of Addiction Medicine (ASAM) recommend considering off-label psychostimulants under a comprehensive treatment plan for StUD. This includes thorough histories, risk monitoring, and drug testing. www.asam.org/quality-care...