Case Study: Buprenorphine/Naloxone for Opioid Use Disorder
For people addicted to opioids, treatment involving buprenorphine and naloxone has proven effective. The combination has been studied by a number of researchers who have found that buprenorphine/naloxone for opioid use disorder can be helpful in treating even critically ill patients.
The Opioid Crisis in the Time of COVID
During the COVID-19 pandemic, the incidents of drug overdose traced to opioids has increased significantly. Opioids, especially synthetic drugs, are the main cause of drug overdose fatalities. Opioids include heroin and prescription pain relievers such as hydrocodone, oxycodone, morphine, and fentanyl.
Overdose deaths have increased from 16,682 during the first three months of 2019 to an estimated 19,416 in the first three months of 2020. Approximately 75,500 overdose deaths occurred between March 2019 and March 2020, representing an increase of 10%. Of the individual states, seven experienced increases ranging from 25% to 50% during that same time period.
Treating Dependence on Opioids
Buprenorphine/naloxone works in the brain to help treat the individual who is addicted to opioids. It can be taken at home, when prescribed and supervised by a treatment professional, as part of an addiction treatment program.
The active drug is buprenorphine, known as a partial opioid agonist. That means it works, partially, like an opioid with a “ceiling effect” so the opioid effects level off. The use of buprenorphine works to reduce the risk of misuse, dependency, and side effects. As an opioid agonist medication, it lowers the effects of opioid dependency such as withdrawal symptoms and cravings without the full opioid potency or effects. It’s been proven effective in helping individuals abstain from other opioids.
Naloxone is the opioid antagonist or blocker. The medication is taken by tablet or dissolvable film. When naloxone is injected, it causes the individual who is dependent on opioids to have uncomfortable withdrawal symptoms. This reaction helps to discourage anyone who is dependent on intravenous opioids from injecting buprenorphine/naloxone.
Case Study of a Critically Ill Patient
Buprenorphine/naloxone is typically not initiated for opioid use disorder treatment in critically ill patients when opioids are required to keep them sedated. However, a recent case study involving a critically ill 29-year old woman with an opioid use disorder found that buprenorphine/naloxone could be safely administered with effective results.
In the case report, published in the Journal of Addiction Medicine, the physicians discuss the treatment of the woman who was admitted for infective endocarditis and septic shock which required her to be intubated for respiratory failure. Given her opioid addiction, she required doses of fentanyl and dexmedetomidine to keep her sedated so the medical team could treat her pain as well as her opioid withdrawal. The patient was successfully started on buprenorphine/naloxone using a rapid micro-induction technique that did not cause precipitated withdrawal or require cessation of her fentanyl infusion.
Medical professionals strongly recommend opioid agonist treatment be initiated with buprenorphine/naloxone as the preferred first-line treatment whenever possible. Due to its pharmacological properties, however, induction can be challenging, requiring the cessation of all opioids for a certain amount of time to avoid the risk of potential withdrawal symptoms.
The case study authors report that the young woman’s case illustrates a new method for starting buprenorphine/naloxone in a critically ill intubated patient, where buprenorphine/naloxone was never a consideration in this specific patient population. The newly proven method can now be used to minimize the barriers to opioid agonist therapy in intubated patients.
Buprenorphine/Naloxone Use
While it has been proven effective in treating opioid addiction, buprenorphine/naloxone should be started only after it’s been determined by a healthcare professional that is safe to do so. If it is started too early after using other opioids, the individual could experience withdrawal symptoms, such as sweating, shaking, nausea, vomiting, diarrhea, body aches, anxiety, irritability, or runny nose. Buprenorphine/naloxone treatment should be combined with counseling and other support to help the individual overcome an addiction to opioids successfully.
Contact Recovery Without Walls for Help
At Recovery Without Walls, we offer innovative pharmacological intervention and integration techniques designed to help you overcome your addiction to opioids. We are an evidence-based medical practice, focused on comprehensive health and continuing recovery. Our professional staff provides individualized treatment, to address your specific needs in a whole-body approach. During COVID-19, we believe that early intervention can save lives and we urge you to contact us today for help.
