(160) Buprenorphine/naloxone for treatment of borderline personality disorder: review of the role of opioid system and results from the pilot study

Abstract: Consult-liaison psychiatrists frequently run into patients who are admitted to hospitals with complications of their opioid use disorders, ranging from simple withdrawal symptoms to endocarditis or HIV. A lot of these patients have comorbid diagnosis of borderline personality disorder (BPD). 44% of patients seeking treatment at an outpatient buprenorphine maintenance clinic was shown to have BPD (1). Based on the opioid deficit theory, the low basal endogenous opioid level in BPD could explain their sense of emptiness and chronic dysphoria and compensatory upregulation of mu-receptors could be reflected in rewarding effects of self-injurious behaviors and opioid use (1). This may explain such a high prevalence of this comorbidity, which results in more severe and persistent course of both disorders with increased negative consequences. As the opioid partial agonist, buprenorphine may be of therapeutic benefit for BPD as well as OUD. To this date, there is no FDA approved medications for the treatment of BPD, and it would be important to look at whether Suboxone could be an effective treatment option for this patient population.

Our IRB approved study takes place at University of Virginia outpatient based opioid treatment clinic. It enrolls patients who have comorbid diagnoses of opioid use disorder (OUD) and BPD based on DSM criteria and psychiatric interview and are eligible for the treatment with Suboxone. After providing consent, subjects fill out the Borderline Evaluation of Severity over Time (BEST) questionnaire before they get started on Suboxone and then fill out the same questionnaire again at a 1-month follow up visit to assess the change in the severity of BPD symptoms. We had one patient who initially scored 41 on the questionnaire that dropped down to 15 subsequently, which indicates significant improvement in BPD symptoms with Suboxone treatment. The pilot study is ongoing and I will have more data by the conference time. If the study continues to show positive changes with BPD symptoms on Suboxone treatment, it will further underscore the importance of initiating treatment with Suboxone for the patients with comorbid diagnoses and bridging them to the outpatient opioid treatment team. Treatment for this patient population may be provided through the coordinated efforts of individual and/or group therapists, a substance abuse counselor, a psychiatrist, and a primary care provider (2). Education of the treatment teams and patients of the potential therapeutic effects of Suboxone may transform the management of these patients and even for BPD patients without OUD in future.

References
1. Bassir Nia, Anahita. “Opioid Addiction and Borderline Personality Disorder.” The American Journal on Addictions, vol. 27, no. 1, 2017, pp. 54–55., https://doi.org/10.1111/ajad.12664.

< ! 2. An Introduction to Co-Occurring Borderline Personality ... https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4879.pdf.