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High-Dose Buprenorphine Induction in ED Seems Safe for Treating OUD

High-dose buprenorphine protocol well tolerated in patients with untreated opioid use disorder; no reports of respiratory depression or sedation

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FRIDAY, July 16, 2021 (HealthDay News) -- For patients with untreated opioid use disorder (OUD) presenting to the emergency department, high-dose buprenorphine induction seems safe and is well tolerated, according to a study published online July 15 in JAMA Network Open.

Andrew A. Herring, M.D., from the Highland Hospital-Alameda Health System in Oakland, California, and colleagues examined the safety and tolerability of high-dose (>12 mg) buprenorphine induction in a case series of patients presenting to the emergency department with OUD. Data were included for 391 unique patients, representing 579 encounters.

During 366 encounters, 54 unique clinicians administered a high dose of sublingual buprenorphine, including 138 doses that were ≥28 mg. The researchers observed no cases of respiratory depression or sedation. No association with dose was seen for the five cases of precipitated withdrawal (0.8 percent); four cases occurred after doses of 8 mg of buprenorphine. There were three serious adverse events, which were unrelated to buprenorphine. Nausea and vomiting occurred infrequently (2 to 6 percent of cases). Patients had a median length of stay of 2.4 hours.

"The extended opioid blockade provided by the high-dose pathway may impart more substantial overdose protection and more effective blunting of the euphoric and reinforcing effects of any opioids used in the high-risk window following emergency department departure prior to engagement in follow-up care," the authors write.

One author disclosed financial ties to the biopharmaceutical industry.

Abstract/Full Text

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