This course will review high dose opioid to partial agonist (buprenorphine) transitions and get into the nitty gritty of buprenorphine initiation. Clinicians struggle with when to consider buprenorphine for pain or OUD (when is it appropriate for opioid naïve vs. tolerant vs. highly tolerant vs. patient using non-prescribed opioids) and this course will use case examples to walk through patient specific factors and considerations for appropriate buprenorphine candidates. Types of buprenorphine initiation strategies, goal dosing of buprenorphine for pain management versus opioid use disorder, and a review of the most recent literature on micro initiations will be presented to the audience. Clinical patient case examples of transitions from various regimens such as high dose patient controlled analgesia, methadone, transdermal fentanyl, and non-prescribed opioids to buprenorphine will be presented. Two clinical pharmacist specialists in pain management and a board certified addiction medicine physician, who currently practice on addiction consult teams at large academic medical centers will present the challenges and barriers to treatment that clinicians may encounter within their own practice including formulation availability constraints (due to drug shortages, cost, or formulary restriction), transitions of care logistics (transportation, follow up care, clinical setting), buprenorphine resources for providers and patients when prescribed for either pain management or opioid use disorder, and additional clinical pearls that can be applied immediately into various clinical practice arenas. At the end of this course multidisciplinary team member should be equipped with specific case examples and successful strategies for starting buprenorphine in patients within their own practice site.