Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients

Ang-Lee, Kathleen; Oreskovich, Michael R.; Saxon, Andrew J.; Jaffe, Craig A.; Meredith, Charles; Ellis, Mei Ling; Malte, Carol A.; Knox, Patricia

doi:10.1080/02791072.2006.10400589

Cited by 18 publications

(25 citation statements)

References 19 publications

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“…For most individuals with OUD, higher doses are required for effective agonist blockade and suppression of opioid withdrawal and craving. [15][16][17][18][19][20][21] An accelerated induction procedure that achieves therapeutic buprenorphine levels obtained in less than 3 to 4 hours, vs the typical 2 to 3 days, could potentially increase safety during the crucial gap between ED discharge and continuation of treatment in the outpatient setting. 4,17,22 Thus, we evaluated an ED high-dose (>12 mg) buprenorphine induction clinical pathway (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

et al. 2021

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IMPORTANCE Emergency departments (EDs) sporadically use a high-dose buprenorphine induction strategy for the treatment of opioid use disorder (OUD) in response to the increasing potency of the illicit opioid drug supply and commonly encountered delays in access to followup care.OBJECTIVE To examine the safety and tolerability of high-dose (>12 mg) buprenorphine induction for patients with OUD presenting to an ED. DESIGN, SETTING, AND PARTICIPANTSIn this case series of ED encounters, data were manually abstracted from electronic health records for all ED patients with OUD treated with buprenorphine at a single, urban, safety-net hospital in Oakland, California, for the calendar year 2018. Data analysis was performed from April 2020 to March 2021.INTERVENTIONS ED physicians and advanced practice practitioners were trained on a high-dose sublingual buprenorphine induction protocol, which was then clinically implemented. MAIN OUTCOMES AND MEASURESVital signs; use of supplemental oxygen; the presence of precipitated withdrawal, sedation, and respiratory depression; adverse events; length of stay; and hospitalization during and 24 hours after the ED visit were reported according to total sublingual buprenorphine dose (range, 2 to >28 mg). RESULTSAmong a total of 391 unique patients (median [interquartile range] age, 36 [29-48] years), representing 579 encounters, 267 (68.3%) were male and 170 were (43.5%) Black. Homelessness (88 patients [22.5%]) and psychiatric disorders (161 patients [41.2%]) were common. A high dose of sublingual buprenorphine (>12 mg) was administered by 54 unique clinicians during 366 (63.2%)encounters, including 138 doses (23.8%) greater than or equal to 28 mg. No cases of respiratory depression or sedation were reported. All 5 (0.8%) cases of precipitated withdrawal had no association with dose; 4 cases occurred after doses of 8 mg of buprenorphine. Three serious adverse events unrelated to buprenorphine were identified. Nausea or vomiting was rare (2%-6% of cases).The median (interquartile range) length of stay was 2.4 (1.6-3.75) hours. CONCLUSIONS AND RELEVANCEThese findings suggest that high-dose buprenorphine induction, adopted by multiple clinicians in a single-site urban ED, was safe and well tolerated in patients with untreated OUD. Further prospective investigations conducted in multiple sites would enhance these findings.

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Section: Introductionmentioning

confidence: 99%

High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

et al. 2021

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“…The newer formulations include a depot formulation,[ 10 11 ] as a transdermal patches[ 12 ] and in a high single oral dose. [ 13 14 ] The depot containing 58 mg of buprenorphine in microcapsules was injected subcutaneously. The transdermal patches come in varying strengths and release buprenorphine at a fixed rate.…”

Section: Search Strategymentioning

confidence: 99%

Newer approaches to opioid detoxification

Sarkar

Mattoo

2012

Ind Psychiatry J

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Opioid use disorders present with distressing withdrawal symptoms at the time of detoxification. The pharmacological agents and methods currently in use for detoxification mainly include buprenorphine, methadone, and clonidine. Many other pharmacological agents have been tried for opioid detoxification. This review takes a look at the newer pharmacological options, both opioid agonists and non-agonist medications that have been utilized for detoxification. Peer reviewed articles were identified using PubMed and PsychInfo databases. The keywords included for the search were a combination of ‘opioid’ and ‘detoxification’ and their synonyms. All the articles published in the last 10 years were screened for. Relevant data was extracted from identified studies. Many newer pharmacological agents have been tried in detoxification of opioids. However, the quest for a safe, efficacious, cost-effective pharmacological option which requires minimal monitoring still continues. The role of non-pharmacological measures and alternative medicine needs further evaluation.

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“…In mental diseases, substance connected disorders, have been reported as a raising enigma [12] . According to the published research reports, opioids and stimulants related disorders have caused more admissions to clinics and hospitals [13][14][15][16] . Buprenorphine was accepted for the treatment of pain and opioids withdrawal symptoms [3] .…”

Section: Introductionmentioning

confidence: 99%

“…We ourselves made a Visual Analogue Scale (VAS) and verified it empirically for reliability and validity to grade the methadone withdrawal pain and craving, ranging from 0 to 10 (0 means no craving or pain at all and 10 means severe craving and temptation all the time). We also instructed the subject precisely about scoring [13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Treatment of Chronic Methadone Dependence with Buprenorphine

Ahmadi¹,

Internationals²

2016

JAD

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Background: Methadone abuse is a puzzle. Objective: To uncover the achievement of a single high dose of 64 mg of buprenorphine for the remedy of methadone dependency. Results: 64 mg of buprenorphine as a single administration can be sufficient for the treatment of methadone dependent patient. Discussion: Our study indicates that buprenorphine 64 mg as a single dose only, can be sufficient for the treatment of methadone withdrawal symptoms. So, this work may be a substantial addition to the literature. Conclusions:We can conclude that a single high dose of buprenorphine may be enough for the treatment of methadone withdrawal symptoms.

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Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients

Cited by 18 publications

References 19 publications

High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

Newer approaches to opioid detoxification

Treatment of Chronic Methadone Dependence with Buprenorphine

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