Buprenorphine May Not Be as Safe as You Think

Pediatrics. 2012 Nov 5. [Epub ahead of print]

Kim HK, Smiddy M, Hoffman RS, Nelson LS.

 

Abstract

Buprenorphine is a partial μ-opioid receptor agonist that is approved for the treatment of opioid dependency. It is generally believed to be safer than methadone because of its ceiling effect on respiratory depression. As more adults in US households use buprenorphine, an increasing number of children are being exposed. We report a fatal exposure to buprenorphine in a small child that occurred after ingestion of a caretaker's buprenorphine/naloxone. Postmortem toxicology analysis showed free serum concentrations of 52 ng/mL and 39 ng/mL for buprenorphine and norbuprenorphine, respectively. No other drugs were detected. Autopsy did not find signs of injury or trauma. The theoretical safety provided by the ceiling effect in respiratory depression from buprenorphine may not apply to children, and buprenorphine may cause dose-dependent respiratory depression.

Sudden Cardiac Arrest in a Patient on Chronic Methadone After the Addition of Azithromycin.

Am J Med Sci. 2012 Oct 25
http://www.ncbi.nlm.nih.gov/pubmed/23103438

Drug abuse-related accidents

• During the study period, a total of 166 patients visited the EDs of one of the two study hospitals due to drug abuse-related accidents.
•  Opioids (41.1%) were the drugs most commonly abused by the patients, followed by benzodiazepines (32.1%).
• More than two-thirds of the patients (n=38, 67.9%) required hospitalization, and three patients died (5.4%).

Drug abuse-related accidents leading to emergency department visits at two medical centers.

J Chin Med Assoc. 2012 May;75(5):234-9. Epub 2012 Apr 28.

Methadone mortality Taiwan

Factors associated with mortality among heroin users after seeking treatment with

methadone: A population-based cohort study in Taiwan

• 1616 Taiwanese heroin users between October 2006 and December 2008, central Taiwan (National Taiwan University Hospital Yun-Lin Branch, St. Joseph's Hospital, China Medical University Beigang Hospital, and National Cheng Kung University Hospital Dou-Liou Branch),
• linkage with the National Death Certification Registry system
• Opiate Treatment Index (OTI),
• 26 (1.6%) people died, with an all-cause mortality rate per 100 person years of 3.42
• The primary cause of death  was
• accidents,
• suicide
• drug overdose
• Older age, HIV infection, psychiatric treatment history, and alcohol abuse/dependence were risk factors for all-cause mortality;
• remaining on MMT was protective for survival

Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. J Subst Abuse Treat. 2012 Sep 25. pii: S0740-5472(12)00138-9. doi: 10.1016/j.jsat.2012.08.003. [Epub ahead of print]


Charles Lung-Cheng Huang, M.D.a,b, Lee Chung-Wei, Master c
a Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
b Department of Nursing, Chung-Hwa University of Medical Technology, Tainan, Taiwan
c Department of Psychiatry, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan