Rapid induction onto extended-release injectable buprenorphine following opioid overdose: A case series

Drug Alcohol Depend Rep. 2023 Mar 16:7:100144. doi: 10.1016/j.dadr.2023.100144. eCollection 2023 Jun.

Abstract

Background: Buprenorphine treatment has been associated with reduced non-prescribed opioid use and opioid related overdose (OD). We evaluated initial outcomes of rapid induction onto extended-release injectable buprenorphine (BUP-XR) within 7 days of emergency department presentation for unintentional OD.

Methods: Between February 2019-February 2021, N = 19 patients with opioid use disorder received buprenorphine/naloxone (4/1 mg), followed by BUP-XR (300 mg) at induction and continued BUP-XR outpatient for 6 months. Primary outcomes included adverse events, repeat OD, and death.

Results: For patients who received at least one dose of BUP-XR, there were no treatment related serious adverse events or symptoms of precipitated withdrawal. In addition, there were no repeat visits for ODs or deaths within 6 months of the initial OD.

Discussion: These preliminary findings support the need for larger controlled clinical trials to examine the safety and efficacy of rapid induction of BUP-XR in patients with opioid use disorder at high risk of opioid OD. Rapid induction onto long-lasting injectable buprenorphine may be a promising and protective treatment approach in the future.

Keywords: Addiction medicine; Buprenorphine; Emergency department; Extended-release buprenorphine; Fentanyl; Health disparities; Injectable buprenorphine; Medications for opioid use disorder; Opioid overdose; Opioid use disorder; Overdose; Rapid induction.