Date of Conferral

4-15-2026

Degree

Ph.D.

School

Psychology

Advisor

Delinda Mercer

Abstract

The emergence of illicitly manufactured fentanyl has increased clinical uncertainty during buprenorphine induction in medication-assisted treatment for opioid use disorder. The purpose of this quantitative, retrospective cohort study, guided by the Transtheoretical Model (TTM), was to examine whether prescriber-level buprenorphine induction practices and experiences with precipitated withdrawal were associated with reported buprenorphine induction challenges, and whether county-level fentanyl prevalence contributed to these challenges after accounting for geographic clustering. Secondary, de-identified archival data were obtained from the National Institute on Drug Abuse Clinical Trials Network study CTN-0134 and included 64 prescribers practicing in fentanyl-endemic settings. Buprenorphine induction challenges were operationalized as a binary prescriber-reported outcome indicating whether induction was declined or modified due to fentanyl-related concerns. Binary logistic regression and a generalized linear mixed model were used for analysis. No prescriber-level induction practices, experiences with precipitated withdrawal, or county-level fentanyl positivity rates were significantly associated with reported induction challenges. Findings were interpreted as inconclusive, with emphasis placed on effect estimates and confidence intervals. Results highlight the complexity of buprenorphine induction decision-making in fentanyl-endemic settings and support the need for refined outcome measures and adequately powered future research.

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