High Dose Buprenorphine Reduces Symptoms in Untreated Emergency Department Patients With Opioid Use Disorder
High-dose buprenorphine is a widely used medication to reduce the symptoms of untreated opioid use disorder. However, this treatment is not appropriate for every patient and can have adverse side effects. This article examines the benefits and risks of high-dose buprenorphine and its appropriateness for different patients.
Symptoms of untreated opioid use disorder
The emergency department (ED) is an important place to recognize the signs and symptoms of opioid use disorder. If an opioid-addicted patient presents in the ED, a physician should follow evidence-based interventions for the disorder. By identifying patients at risk for opioid use, emergency physicians can help improve patient care and reduce the number of opioid-related deaths.
This study used an electronic health record to collect data from emergency departments across five states and five healthcare systems. The study population included 5047 adult patients with opioid use disorder and 599 attending emergency physicians. In all, the study population had a median age of 36 years, and the interquartile range was 29 to 47. Most patients were white and had Medicaid insurance.
Mechanism of action of high-dose buprenorphine
In an experiment involving 391 individuals treated in the emergency department, researchers found that high-dose buprenorphine significantly improved symptoms and reduced risk factors of opioid use disorder. The patients received a dose ranging from two to four milligrams (mg/kg) and received a second dose two hours later. The study used a clinical form that captured the patients’ opioid use history, the nature of their ED visit, and the outcomes of treatment. Expert clinicians independently of the clinical site reviewed the data to identify any potential adverse events.
The authors of the study reported having received grants from California Bridge and the National Institute on Drug Abuse Clinical Trials Network during the study’s conduct. In addition, they received travel reimbursements from Alkermes and Indivior.
Appropriateness of high-dose buprenorphine for all patients
High-dose buprenorphine has been shown to reduce symptoms in untreated emergency department patients with opioid use disorder. This treatment is often indicated for patients who have barriers to receiving buprenorphine after discharge. In this high-dose buprenorphine pathway, patients receive an initial dose of four to eight mg SL and are reassessed in 30 to 45 minutes. The high-dose buprenorphine dosage is determined by the level of withdrawal and can be increased to a maximum of 24 mg daily.
The study looked at 391 patients treated in the ED with high-dose buprenorphine. Patients received a high dose of 32 mg, which was effective for almost half of them. In addition to reduced symptoms, high-dose buprenorphine also reduced respiratory rates, decreased oxygen saturation, and rescue naloxone administration.
Adverse effects of high-dose buprenorphine
A recent study of 579 emergency department visits by 391 adults with opioid use disorder at Alameda Health System-Highland Hospital in Oakland, California, found that high-dose buprenorphine was safe for most patients. While there were some reported cases of adverse effects, the majority of patients did not experience significant withdrawal symptoms, which suggests that higher doses of buprenorphine are generally safe.
The findings of the study are especially relevant today, given the increased potency of illicit drugs and delays in accessing follow-up care. The study’s authors believe that buprenorphine may be an effective treatment option for opioid addiction and the rise of overdoses in emergency departments.
