Local doctors are helping patients get off fentanyl with a pioneering treatment.

The scourge that is fentanyl not only puts its users at risk of a deadly overdose, it also becomes a relentless cycle where the user no longer gets high, they just need it to avoid the pain of withdrawal. Getting patients off that cycle has been a challenge, but a new treatment method evolving on the streets of Monterey County is showing promise of helping them finally break free.

The method, called Direct to Inject, or DTI, allows physicians to transition patients onto buprenorphine in a way that wasn’t previously available, explains Dr. Reb Close, an addiction specialist with Pacific Rehabilitation and Pain in Monterey and president of the nonprofit Central Coast Overdose Prevention. “Bupe,” as it’s also known, works by binding to opioid receptors in the brain, partially activating the receptors, but not fully, and in the process blocking other opioids from accessing the receptors.

Previously, Close and her colleagues instructed patients to microdose bupe as they continued to use substances, allowing the bupe to slowly build up in the body until the original substance is no longer needed. In the past six months, the protocol has changed as specialists in other cities, who also work with patients in the streets, have found success with directly injecting those patients with initial larger doses.

A new doctor joined the Monterey practice, Dr. Andrea Jakubowski, from New York, where they had started injecting patients with a slightly larger initial dose, followed about a week later with a full monthly dose. Close was skeptical but reports: “It totally worked.”

Then a manufacturer developed a new timeline using two full doses a week apart before starting a monthly regimen.

Close tried the new dosage schedule on two patients successfully. Neither went through a big withdrawal and they no longer felt the need to use fentanyl.

“This is the revolutionary thing we’re able to do on the street,” Close says. DTI, she says, is giving patients a way out.