Intravenous use of illicit buprenorphine/naloxone to reverse an acute heroin overdose
DOI:
https://doi.org/10.5055/jom.2012.0098Keywords:
buprenorphine/naloxone, Suboxone, overdose, opioid overdose, opiate overdose, naloxone, lay responder, injection drug usersAbstract
A case of heroin overdose reversed through the intravenous (IV) administration of a crushed sublingual tablet of buprenorphine/naloxone (Suboxone®) by a lay responder is described. Although the sublingual administration of buprenorphine/naloxone to reverse an overdose has been reported elsewhere, this is the first report of IV administration. Healthcare professionals should be aware that injection drug users may respond to an opioid overdose by injecting buprenorphine/naloxone and should consequently counsel all opioid-using patients on the proper response to an overdose. Physicians should also consider prescribing naloxone to at-risk patients. The work of community-based naloxone distribution programs should be expanded.References
Fingerhut L: Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005. Atlanta, GA: Centers for Disease Control and Prevention, 2006. Available at http://www.cdc.gov/nchs/data/hestat/poisoning/poisoning. htm. Accessed February 2011.
United States Department of Justice; Drug Enforcement Agency (DEA): DEA: Drugs of Concern: Buprenorphine. 2011. Available at http://www.deadiversion.usdoj.gov/drugs_concern/buprenorphine.pdf. Accessed May 1, 2011.
Centers for Disease Control and Prevention: Unintentional Drug Poisoning in the United States. Atlanta, GA: Centers for Disease Control, 2010: 1-4.
Warner-Smith M, Darke S, Lynskey M, et al.: Heroin overdose: Causes and consequences. Addiction. 2001; 96(8): 1113-1125.
Beletsky L, Burris S, Kral A: Closing Death’s Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States (Conference Report). 2009. Philadelphia, PA: The Center for Law, Politics, and Policy, Temple University Beasley School of Law, 2009: 39.
Green TC, Heimer R, Grau LE: Distinguishing signs of opioid overdose and indication for naloxone: An evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. 2008; 103(6): 979-989.
Kerr D, Kelly A-M, Dietze P, et al.: Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction. 2009; 104(12): 2067-2074.
Doe-Simkins M, Walley A, Epstein A, et al.: Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opioid overdose. Am J Public Health. 2009; 99(5): 788-791.
Maxwell S, Bigg D, Stanczykiewicz K, et al.: Prescribing naloxone to actively injecting heroin users: A program to reduce heroin overdose deaths. J Addict Dis. 2006; 25(3): 89-96.
Piper TM, Stancliff S, Rudenstine S, et al.: Evaluation of a naloxone distribution and administration program in New York city. Subst Use Misuse. 2008; 43(7): 858-870.
Seal K, Downing M, Kral A, et al.: Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: A survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. 2003; 80(2): 291-301.
Welsh C, Sherman SG, Tobin KE: A case of heroin overdose reversed by sublingually administered buprenorphine/naloxone (Suboxone). Addiction. 2008; 103(7): 1226-1228.
Boyd J, Randell T, Luurila H, et al.: Serious overdoses involving buprenorphine in Helsinki. Acta Anaesthesiol Scand. 2003; 47(8): 1031-1033.
Mendelson J, Jones RT: Clinical and pharmacological evaluation of buprenorphine and naloxone combinations: Why the 4:1 ratio for treatment? Drug Alcohol Depend. 2003; 70(2 Suppl): S29-S37.
Bickel WK, Stitzer ML, Bigelow GE, et al.: Buprenorphine: Dose-related blockade of opioid challenge effects in opioid dependent humans. J Pharmacol Exp Ther. 1988; 247(1): 47-53.
United States Substance Abuse and Mental Health Services Administration: Center for Substance Abuse Treatment. Buprenorphine. Rockville, MD: US Federal Government, 2010. Available at http://buprenorphine.samsha.gov. Accessed October, 2010.
United States Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol 40 (TIP 40): Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, MD: US Federal Government, 2004: 169.
United States Department of Justice, Drug Enforcement Agency (DEA): Buprenorphine (Trade Names: Buprenex, Suboxone, Subutex). Springfield, VA: US Federal Government, 2011. Available at http://www.deadiversion.usdoj.gov/drugs_concern/buprenorphine.pdf. Accessed May 1, 2011.
Bazazi AR, Yokell M, Fu J, et al.: Illicit use of buprenorphine/naloxone among injecting and non-injecting opioid users. J Addict Med. 2011; 5(3): 175-180.
Monte A, Mandell T, Wilford B, et al.: Diversion of buprenorphine/naloxone coformulated tablets in a region with high prescribing prevalence. J Addict Dis. 2009; 28(3): 226-231.
Nielsen S, Lintzeris N: The sublingual use of buprenorphinenaloxone for reversing heroin overdose: A high-risk strategy that should not be recommended. Addiction. 2008; 103(12): 2066-2067.
Raffa RB, Pergolizzi JV Jr: Opioid formulations designed to resist/deter abuse. Drugs. 2010; 70(13): 1657-1675.
United States Food and Drug Administration: FDA Approves New Formulation for OxyContin. FDA Press Release. April 5, 2010.
Okie S: A flood of opioids, a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981-1985.
Rich J, McKenzie M, Green T: Response to “A flood of opioids, a rising tide of deaths”. N Engl J Med. 2011; 364(7): 686.
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved