The authors acknowledge comments regarding the low precipitated withdrawal rate in their study, noting that 40% of participants tested positive for buprenorphine at baseline. They agree that even excluding these individuals would not significantly alter the low precipitated withdrawal rate. One patient who experienced precipitated withdrawal did have buprenorphine in their urine. The authors recognize the importance of local context and urine testing when initiating buprenorphine. Their study's prospective design and rigorous definition of precipitated withdrawal offer greater reliability than anecdotal evidence. To their knowledge, this is the first large prospective trial reporting precipitated withdrawal rates in fentanyl users. They found that individuals using daily fentanyl, when carefully assessed and meeting clinical criteria, could safely start buprenorphine with minimal precipitated withdrawal. The availability of additional buprenorphine doses and ancillary medications in their emergency department setting is highlighted. This accessibility may not be replicated in other clinical environments. The study demonstrates that careful evaluation ensures safe buprenorphine initiation even in the context of fentanyl use.