(2) Intravenous Buprenorphine for Opioid Withdrawal: A Case Series

Background: After sublingual (SL) formulations of buprenorphine became commercially available to treat opioid use disorder in the US in 2002, they became the standard of care for treatment of opioid withdrawal. However, in some instances SL buprenorphine is not appropriate (e.g. in the setting of intractable vomiting, respiratory compromise, or altered mental status). While observed to be safe and effective in the pre-sublingual era (1, 2), current practitioners have limited experience with the intravenous (IV) formulation of buprenorphine.

Methods: We present a case series of eight patients at an urban public hospital in the Northeastern United States who received IV buprenorphine for treatment of opioid withdrawal or opioid use disorder. Charts were reviewed for patient demographics, medical history, substance use history, urine drug screens, clinical scenario, dose of buprenorphine, vital sign trends, and any measure of change in withdrawal.

Results: All eight patients received IV buprenorphine to treat presumed opioid withdrawal. The standard dose was 0.3mg, and if dosed more than once was given every six hours. In two instances, two loading doses of 0.3mg for a total of 0.6mg IV was needed for resolution of withdrawal. All eight tolerated the IV buprenorphine without hemodynamic decompensation (e.g. hypotension). No adverse events were noted. Withdrawal was static or improved in all patients, and in multiple cases allowed for resolution of the limiting issue preventing use of SL buprenorphine.

Conclusion: In a case series of patients with opioid withdrawal, intravenous buprenorphine was a safe and effective treatment that demonstrated no adverse events. It improved withdrawal in most patients and should be considered as a safe treatment by practitioners in cases where sublingual buprenorphine is not safe or preferred.

References: (1) Welsh CJ, Suman M, Cohen A, Broyles L, Bennett M, Weintraub E. The use of intravenous buprenorphine for the treatment of opioid withdrawal in medically ill hospitalized patients. Am J Addict. 2002 Spring;11(2):135-40.
(2) Kuhlman JJ Jr, Lalani S, Magluilo J Jr, Levine B, Darwin WD. Human pharmacokinetics of intravenous, sublingual, and buccal buprenorphine. J Anal Toxicol. 1996 Oct;20(6):369-78.
(3) Umbricht, A. , Huestis, M. A. , Cone, E. J. & Preston, K. L. (2004). Effects of High-Dose Intravenous Buprenorphine in Experienced Opioid Abusers. Journal of Clinical Psychopharmacology, 24 (5), 479-487