Challenges with buprenorphine inductions in the context of the fentanyl overdose crisis: A case series. (13th October 2021)

• Record Type: Journal Article
• Authors: Shearer, Daniel; Young, Samantha; Fairbairn, Nadia; Brar, Rupinder
• Is Part Of: Drug and alcohol review. Volume 41:Number 2(2022)
• Page Start: 444
• Page End: 448
• Publication Date: 2021-10-13
• Subjects: addiction medicine -- buprenorphine -- fentanyl -- opiate substitution treatment -- precipitated withdrawal; Substance abuse -- Periodicals; Alcoholism -- Periodicals; Drinking of alcoholic beverages -- Periodicals; 616.86
• DOI: 10.1111/dar.13394
• Languages: English
• ISSNs: 0959-5236

Abstract

Abstract: Introduction and Aims: North America is currently experiencing an epidemic of opioid overdose deaths, driven by the proliferation of fentanyl in the street drug market. Although buprenorphine/naloxone (BUP/NX) is an evidence‐based, first‐line opioid agonist for the management of opioid use disorder, a key challenge in its prescribing lies in the fact that it can precipitate opioid withdrawal during its initial induction process. At this time, there is minimal literature on the BUP/NX induction process in individuals who use illicit fentanyl regularly. Design, Methods and Results: A case series from a Vancouver, Canada addiction medicine clinic of three fentanyl‐exposed patients who experienced unexpected, precipitated withdrawal when initiating BUP/NX. Discussion and Conclusion: These cases describe incidents of precipitated opioid withdrawal occurring after unusually long periods of fentanyl abstention. Although fentanyl is experienced as a short‐acting opioid, the drug persists much longer in the body's peripheral tissues. Here, we highlight the new challenges fentanyl may pose to current BUP/NX induction strategies, and explore the possibility of a long‐acting pharmacokinetic effect of fentanyl in the setting of repeated illicit use.