Could a Tablet of Buprenorphine Have Saved the Life of Philip Seymour Hoffman?

Philip Seymour Hoffman died from “acute mixed drug intoxication,” according to the newly released official autopsy. The cocktail of controlled substances that led to his tragic death included heroin, cocaine, benzodiazepines, and amphetamines, as reported by Julie Bolcer of the New York City Medical Examiner’s Office.

We find it noteworthy that, in addition to the dozens of heroin bags found in his apartment, Hoffman also had tablets of the specialized analgesic and addiction drug, buprenorphine. When mixing drugs, opiates greatly exacerbate the likelihood of overdose. Could a tablet of buprenorphine have saved the life of Philip Seymour Hoffman?

Buprenorphine has a unique effect on the human nervous system. Like other opiates, such as OxyContin (oxycodone), Vicodin (hydrocodone) and heroin (known in England as diacetylmorphine), buprenorphine activates the μ-opioid receptor. However, buprenorphine has a higher binding affinity for the receptor than any other opioid, while simultaneously acting in a “partial” or less disruptive way. As a result, respiratory depression and cardiac arrest (syndromes associated with heroin and other full-agonist opiates, such as oxycodone) are significantly less associated with buprenorphine. Consequently, buprenorphine can actually reduce the binding of these dangerous opiates from the μ-opiate receptor and prevent fatal outcomes. In addition, this unique binding often reduces neuropathic and other complex types of pain untouched by other opioids.

Buprenorphine was the result of a forty-year search for a non-euphoric but effective painkiller and, when used in addiction, causes much less craving and a minimal “high” for most addicts. Therefore, it can often miraculously stabilize the lives of both addiction and pain patients.

What if some of the buprenorphine in Hoffman’s apartment had been in his system on the night of his death on February 1st? Is it plausible that this could have affected the outcome of his tragic situation and given him another chance to get back into recovery?

We believe, that this is highly possible. Dr. Kornfeld has been treating patients with buprenorphine since we started using it for pain patients in the 1990s and he has seen its life saving capacities in potential overdose situations on numerous occasions.

How can we, as practitioners and as a society, utilize this piece of information to prevent tragedies in the future? First, we can spread knowledge of the potential medical uses of buprenorphine for both addiction and chronic pain. Second, we can endeavor to correct dangerous misconceptions that using buprenorphine is just substituting one addiction for another – an impression influenced by the misguided two-part investigation last year by New York Times reporter Deborah Sontag. Third, we can encourage physicians to take the short course in addiction training required by law to prescribe buprenorphine safely for addiction and persuade insurance carriers to pay for this life-saving treatment. Fourth, when evidence surfaces of buprenorphine misuse, we can deploy public health educational teams to better train physicians, patients, and health administrators how to do a better job with this unique drug.

On April 10, 2014 in Orlando, Florida, prior to the Annual Medical Scientific Conference of the American Society of Addiction Medicine, I have the honor of joining a panel of experts discussing “Pain and Addiction: Common Threads.” We will be joined by 300 physicians and others interested in this field to discuss the latest information on buprenorphine. Consider registering for this program while seats are available.