Peckham AM, Kehoe LG, Gray JR, et al. - Findings from clinical trials suggest the noninferiority of extended-release buprenorphine (XR-BUP) to sublingual buprenorphine and indicate it as possibly advantageous, but there is limited data concerning real-world experiences of XR-BUP and uncertainty regarding outcomes for low-threshold clinics with high-risk populations. Further, there is no practical guidance on overcoming treatment challenges, such as inability for some to stabilize on sublingual BUP for 7 days before XR-BUP and ongoing craving/withdrawal symptoms during treatment. Researchers here appraised a retrospective case series of a convenience sample of 40 serial adults with opioid use disorder managed with XR-BUP. In this case series, 65% of patients had negative toxicology for ongoing opioid, which is important given how complex this patient population is, with the majority injecting opioids, experiencing homelessness, and having co-occurring other substance use. Faster initiation of XR-BUP was possible in some patients in certain circumstances, and they remained on a higher dosing regimen of 300 mg monthly with no incidence of precipitated withdrawal, oversedation, or treatment-related adverse effects.