Intravenous Buprenorphine Reversed Opioid-Induced Respiratory Depression Without Precipitating Withdrawal in Emergency Department Patients

Buprenorphine is a high affinity partial agonist that can displace full opioid agonists and could be used to reverse opioid induced respiratory depression. There is scant evidence to support the use of buprenorphine in an acute opioid overdose to reverse respiratory depression in the era of high fentanyl prevalence in the drug supply. This is a case series of four patients with signs and symptoms of an opioid overdose who showed clinical improvement after receiving intravenous buprenorphine. A case series of adult emergency department (ED) patients treated at a single urban academic medical center. Cases were reviewed by authors and determined by consensus whether there was evidence of an acute opioid overdose and if those signs and symptoms were improved after receiving intravenous buprenorphine. All four cases were male patients with a history of opioid use disorder (OUD) and were treated in the ED after an opioid overdose and had signs of respiratory depression. Three of the four cases received naloxone prior to receiving intravenous buprenorphine. Initial doses of intravenous buprenorphine ranged from 0.1 mg to 0.15 mg. None of the patients developed buprenorphine precipitated withdrawal. All of the cases were discharged from the ED with a prescription for sublingual buprenorphine. In this case series patients who received intravenous buprenorphine after an acute opioid overdose had some clinical improvement and did not develop buprenorphine precipitated withdrawal. Further research should be performed to determine the safety and efficacy of intravenous buprenorphine as an opioid overdose reversal agent.