A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Chang, Derek C.; Klimas, Jan; Wood, Evan; Fairbairn, Nadia
• Is Part Of: Journal of addiction medicine. Volume 12:Issue 1(2018)
• Publication Date: 2018-01
• Subjects: buprenorphine -- detoxification -- opioid agonist therapy -- overdose -- taper; Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; Substance-Related Disorders -- Periodicals; 616.86005
• DOI: 10.1097/ADM.0000000000000359
• Languages: English
• ISSNs: 1932-0620

Abstract

Abstract : Background: Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term tapers of opioid agonist/partial agonist medications, such as methadone and buprenorphine/naloxone, are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still commonplace in medically supervised withdrawal settings. Case summary: We report a case of an individual with opioid use disorder who was prescribed a rapid buprenorphine/naloxone taper in a medically supervised withdrawal facility and who had a subsequent opioid overdose and death after discharge. Discussion: The fatal outcome in this case study underscores the potential severe harms associated with use of rapid tapers. Given the increased overdose risk, tapers should be avoided and continuing care strategies, such as maintenance pharmacotherapy, should be initiated in medically supervised withdrawal settings.