Withdrawal from fentanyl has been characterized as more rapid and severe than from other opioids, leading to a higher risk of precipitated withdrawal during buprenorphine initiation. Grounded in the harm-reduction model, microdosing initiation protocols were developed to improve treatment retention and stabilization of patients due to frequent complications arising during conventional initiation protocols. This discussion will review the microdosing initiation protocol along with patient considerations and special populations.