The escalation of the opioid crisis has led to an increase in the treatment of opioid use disorder. In particular, recent legislation has allowed for office-based treatment with buprenorphine, a partial µ-opioid agonist that is believed to be safer than methadone due to a ceiling effect on respiratory depression in adults. An increasing number of children are being exposed to buprenorphine as more adults in US households receive take-home prescriptions. The ceiling effect seen in adults does not seem to apply to young children, and intoxication with severe symptoms including fatalities can occur. This article outlines the pharmacology of buprenorphine and reviews the current literature on overdose in children. We conclude with practical recommendations for limiting potential exposure and damage to children from accidental buprenorphine overdose.
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http://dx.doi.org/10.1177/0009922819829038 | DOI Listing |
J Addict Med
December 2024
From the Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Vancouver, British Columbia, Canada (PA, JSHW, JM, MN, VWL, MJI, NM); Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (PA, MN, VWL, MJI, NM); Addictions and Concurrent Disorders Research Group, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada (JSHW, RMK); Substance Use Response and Facilitation Service, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada (MJI); BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada (NM); Bridge, Public Health Institute, Oakland, CA (AAH); Department of Emergency Medicine, Highland General Hospital-Alameda Health System, Oakland, CA (AAH); Department of Emergency Medicine, University of California, San Francisco, CA (AAH); The C4 Foundation, Coronado, CA (RM); British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada (JSGM); Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (JSGM); and Pharmacokinetics Modeling and Simulation Laboratory, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (ARM).
Buprenorphine has superior safety in opioid use disorder compared with alternatives due to its action as a partial opioid agonist, which limits its ability to cause respiratory depression. There is a risk of precipitated opioid withdrawal after buprenorphine exposure in someone using full opioid agonists. Buprenorphine induction strategies that avoid precipitated withdrawal remain a crucial component for starting buprenorphine in individuals actively using opioids.
View Article and Find Full Text PDFPsychol Addict Behav
January 2025
Department of Psychiatry and Behavioral Sciences, University of Washington.
Objective: Both opioid misuse and overdose mortality have disproportionately impacted the American Indian population. Although medications for opioid use disorder, such as buprenorphine (BUP-NX), are highly effective in reducing overdose mortality, questions have been raised about the cultural acceptability of Western medical approaches in this population. Understanding patients' desired recovery pathways can lead to more culturally appropriate, patient-centered, and effective approaches to opioid use disorder (OUD) treatment.
View Article and Find Full Text PDFPrehosp Emerg Care
January 2025
Wake County Emergency Medical Services, 331 S. McDowell St, Raleigh, NC 27601.
Objectives: Buprenorphine has recently emerged as a prehospital treatment for opioid use disorder. Limited data exist regarding the implementation of prehospital buprenorphine programs. Our objective was to describe the development, deployment, lessons learned, and ongoing evolution of the Wake County EMS buprenorphine program using data from the first year following implementation.
View Article and Find Full Text PDFPrehosp Emerg Care
January 2025
EMS Bridge, Public Health Institute, Oakland, CA.
Objectives: Opioid use disorder (OUD) remains a common cause of overdose and mortality in the United States. Emergency medical services (EMS) clinicians often interact with patients with OUD, including during or shortly after an overdose. The aim of this study was to describe the characteristics and outcomes of patients receiving prehospital buprenorphine for the treatment of opioid withdrawal in an urban EMS system.
View Article and Find Full Text PDFPrehosp Emerg Care
January 2025
Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, AZ.
Objectives: Buprenorphine is becoming a key component of prehospital management of opioid use disorder (OUD). It is unclear how many prehospital patients might be eligible for buprenorphine induction, as traditional induction requires that patients first have some degree of opioid withdrawal. The primary aim of this study was to quantify how many patients developed precipitated withdrawal after receiving prehospital naloxone for suspected overdose, as they could be candidates for prehospital buprenorphine.
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