Case Series Investigates Outcomes of Initiating Buprenorphine After Naloxone-reversed Opioid Overdose in Three Patients

Emergency department (ED) visits following an opioid overdose can be an opportunity for patients with opioid use disorder (OUD) to initiate medications for OUD. However, the safety of administering buprenorphine post-naloxone-reversed opioid overdose is unknown. This single-center series of 3 patients who presented at a California ED assessed whether administering buprenorphine rapidly post-naloxone-reversed overdose was followed by serious adverse events (i.e., additive sedation with respiratory depression or precipitated withdrawal), and if it was followed by engagement in care at a linked bridge clinic.

• In all 3 cases, no serious adverse events were observed during a 6-hour ED visit.
• All 3 patients were still taking buprenorphine (administered by the linked bridge clinic) 7 days after ED discharge.

Comments: Despite the methodological disadvantages of a small case series, vulnerability to selection bias, and low internal validity, the results suggest that administration of buprenorphine post-naloxone reversal of an opioid overdose may be safe and could be a way to initiate long term treatment. Randomized trials should test specified treatment protocols for emergency departments, which could become the new standard of care.

Raagini Jawa, MD, MPH† & Alexander Y. Walley, MD, MSc

† Contributing Editorial Intern and Infectious Disease and Addiction Medicine Fellow, Boston Medical Center

Reference: Herring AA, Schultz CW, Yang E, Greenwald MK. Rapid induction onto sublingual buprenorphine after opioid overdose and successful linkage to treatment for opioid use disorder. Am J Emerg Med. 2019;37(12):2259–2262.