High-Dose Buprenorphine Helped Untreated Opioid Use Disorder

July 23, 2021 - High-dose buprenorphine induction was safe and well-tolerated in patients with untreated opioid use disorder, according to a JAMA Network Open study. 

Researchers gathered data from electronic health records for all emergency department patients with opioid use disorder treated with buprenorphine at a single, urban, safety-net hospital in California in 2018.

Data analysis took place from April 2020 to March 2021.

Out of 391 patients 29 to 48 years of age, 43.5 percent were Black and 14.6 percent were Latinx. About 22.5 percent of patients were homeless and 41.2 percent of patients had comorbid non-substance use-related psychiatric disorders. 

Over half of the patients had never been treated with buprenorphine. 

Researchers explained that multiple clinicians administered a high dose of sublingual buprenorphine during 366 encounters, including 23.8 percent greater than or equal to 28 milligrams. 

There were no cases of respiratory depression or sedation reported. 

Notably, researchers identified serious adverse events related to buprenorphine, including one patient with diabetic ketoacidosis and one patient in withdrawal hospitalized for acute myocardial infarction.

There were just five cases of documented precipitated withdrawal among all cases studied. 

In all withdrawal cases, patients were discharged in stable or improved conditions. In the fifth case, the patient tolerated buprenorphine 8 milligrams and experienced precipitated withdrawal after administering an additional 24 milligrams.

According to the CDC, over 83,000 drug overdose deaths occurred in the US over 12 months, from June 2019 to June 2020. This is the highest number of overdose deaths ever recorded in a 12-month period.

Specifically, this number of overdoses is an increase of over 21 percent compared to the previous year.

Initiation of buprenorphine to treat opioid use disorder in the emergency department, combined with linkage to outpatient care, is an overall effective strategy to reduce mortality and morbidity among individuals living with opioid addiction.

A study from Columbia University Mailman School of Public Health in May 2020 found that long-term buprenorphine treatment was linked to significantly lower rates of prescription opioid use and opioid-related events.

The study found that individuals who continued buprenorphine treatment saw improvements in overall healthcare outcomes. 

Compared to 4,433 adults who discontinued buprenorphine six to nine months after beginning treatment, individuals with continued treatment saw a significantly lower risk of all-cause inpatient (52 percent) and emergency department services (26 percent).

And in January, HHS expanded access to medication-assisted treatment for opioid use disorder.

Under the agency’s guidelines, Practice Guidelines for the Administration for Buprenorphine for Treating Opioid Use Disorder, physicians will be exempt from specific certification requirements needed to prescribe buprenorphine.

The exemption only applies to physicians who only treat patients located in the states in which they are authorized to practice medicine and only applies to the prescription of drugs or formulations covered in the X-waiver of the CSA.