Virginia Opioid Overdose Treatment InitiatVE (VOTIVE)

Inclusion Criteria:

• Signed the informed consent form (ICF) and have the ability to comply with the requirements and restrictions listed therein.
• Age: ≥ 18 years at time of executing the ICF.
• Currently meets DSM-5 criteria for moderate to severe opioid use disorder.
• Must have Clinical Opioid Withdrawal Scale (COWS) score of >8 to be eligible for SUBOXONE dose.
• Is clinically stable (respiratory rate [RR] ≥ 12, pulse oximetry > 95%, Glasgow Coma Scale [GCS] score of 15) and suitable for the trial in investigator or designee's judgement.
• Agrees not to take any buprenorphine products other than those administered during the current study throughout participation in the study.
• Negative urine pregnancy test for females.
• Vital signs (blood pressure, heart rate, temperature) considered within normal limits or non-clinically significant elevation, as assessed by treating physician.

Exclusion Criteria:

• Current diagnosis, other than opioid use disorder, requiring chronic opioid treatment.
• Active suicidal ideation in opinion of investigator or designee.
• Female subject that is lactating, pregnant or planning to become pregnant during their participation in the study.
• Uncontrolled intercurrent illness including, but not limited to, psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to provide written informed consent, signs of opioid toxicity more than 2 hours from naloxone administration or subjects with evidence of pulmonary edema.
• Known allergy or hypersensitivity to SUBOXONE.
• Any condition that, in the opinion of the investigator would interfere with interpretation of subject safety or study results.
• Currently receiving medication assisted treatment (MAT) for opioid use disorder (OUD) (e.g. methadone, buprenorphine) or received MAT as a treatment for OUD within 30 days prior to consent.
• Concurrent treatment with another investigational agent.
• Concurrent enrolment in another clinical study, or observational study that includes MAT.
• Treatment for opioid use disorder required by court order.
• Current or pending incarceration/ legal action that could affect participation or compliance in the study.
• Subjects who are unable, in the opinion of the investigator, to comply fully with the study requirements.
• Less than 48-72 hours since last use of long acting opioids (e.g., methadone), by self-report.
• Current intoxication with benzodiazepines or alcohol.
• Meet current DSM-5 diagnosis for severe Benzodiazepine or Alcohol Use Disorder, or endorse benzodiazepine or alcohol withdrawal symptoms.
• Current illicit opioid users who endorse regular use of long acting opioids (e.g. methadone).
• Total bilirubin ≥ 1.5x the upper limit of normal (ULN), alanine aminotransferase (ALT) ≥3xULN, aspartate aminotransferase (AST) ≥ 3xULN, serum creatinine > 2xULN, international normalized ratio (INR) >1.5xULN
• Patients with a history of Long QT Syndrome or an immediate family member with this condition or those taking Class lA antiarrhythmic medications (e.g., quinidine, procainamide, disopyramide) or Class Ill antiarrhythmic medications (e.g., sotalol, amiodarone, or other mediations that prolong the QT interval.