At Boulder Care, we believe treatment isn’t delivered; it’s co-created. That belief is central to how we care for people starting care with buprenorphine, particularly those transitioning from fentanyl and other opioids.
While medications for opioid use disorder (MOUD) are evidence-based and lifesaving, the method by which people initiate treatment matters just as much as the medication itself. Traditional transition protocols often don’t account for the individual goals, fears, and circumstances of each patient. This is an especially dangerous omission in the fentanyl era, where variability in tolerance and withdrawal responses can make the transition more intense and more daunting.
That’s why Boulder utilizes a shared decision-making (SDM) approach: a collaborative care model that centers patient autonomy and lived experience, ensuring every person is fully informed and supported in choosing how they start treatment.
At Boulder, we offer multiple evidence-informed options for transitioning onto buprenorphine: QuickStart, high-dose, standard, and low-dose. Rather than prescribing a one-size-fits-all path, our care team walks through each option with patients, helping them weigh the pros and cons of each option, and in turn identify what feels most manageable given their needs, responsibilities, and recovery goals.
Hundreds of thousands of Americans who feel trapped by high-potency synthetic opioids believe that buprenorphine treatment can’t help them so don’t pursue available treatment. At Boulder we have seen shared decision-making open that door to a new narrative and a path to self-directed recovery for thousands of people.
A Support System That Stays With You
Peers play a vital role in the shared decision-making process. At Boulder, peer support specialists are integrated into care early, often brought in by clinicians during intake to help patients explore which transition method might feel most aligned with their needs and goals.
With lived experience navigating similar decisions, peers are uniquely equipped to sit with patients through moments of fear, uncertainty, or doubt – including when making a decision that can feel overwhelming or high-stakes. They help normalize these feelings and offer a steady presence before, during, and after the transition.
Their role isn’t to push any particular method, but to walk alongside patients as they weigh options, ask questions, and make an educated choice for themselves.
For instance, a patient facing an upcoming court date might choose QuickStart or a high-dose method to make a rapid transition, stabilize quickly, and demonstrate to their probation officer that they’ve engaged in treatment. Speed and predictability matter most in that moment, and the entire care team works together to support the plan.
Another patient might choose a low-dose transition because they’re managing childcare responsibilities and can’t risk being sidelined by withdrawal. Easing into treatment more gradually can help this patient maintain stability at home, avoid “feeling sick,” and stick with a plan that honors both their recovery and their daily life demands.
And critically: If a transition method doesn’t work, peers help patients regroup without shame or blame – because at Boulder, trying again isn’t a setback. It’s part of the process.
There’s No Wrong Door, Just the Right Fit
At Boulder, if a transition method doesn’t work for a patient, we don’t see that as a failure – because it isn’t. What didn’t work was the match between the method and the patient, not the patient themselves.
In fact, we know that framing these moments as “failures” can be deeply harmful, reinforcing shame, eroding trust, and – too often – pushing people out of care.
That’s why we reject the binary opposition of “success vs. failure” in treatment and recovery. Instead, we focus on fit: finding the right option for this person, at this time, by treating them as the expert on their own body, life, and goals.
More Options → Better Outcomes
This approach not only affirms patient dignity and autonomy. It works.
Our data demonstrate that patients who use more than one transition method early in their care journey – those often seen as at high risk for dropping out – actually have higher retention rates in their first 6 months.
This is remarkable. These are often patients the field has historically given up on: people who were expected not to return after a “failed” transition attempt. But when we meet those patients with curiosity instead of judgment, and with options instead of ultimatums, they don’t give up. They come back. They stay.
We also found that across nearly all transition methods – low-dose, high-dose, QuickStart, and standard – patients with Boulder had 30-day retention rates exceeding 70%. These numbers surpass national averages and demonstrate that when people are given meaningful choices and the trust to guide their own care, they’re more likely to engage and stick with it.
Looking Forward
Recovery isn’t linear – and neither is care. At Boulder, we’re committed to listening, learning, and improving as we go.
As the landscape of opioid use changes, so must the models we use to meet it. Recovery doesn’t start with mandates or ultimatums; it starts with listening. And when we listen – really listen – patients show us what’s possible.
