Study: Higher Doses of Buprenorphine Safe, Well Tolerated in Emergency Departments

When administered by emergency department caregivers, high-dose buprenorphine therapy is safe and well tolerated in individuals with opioid use disorder who are experiencing withdrawal symptoms, according to results of a study supported by the National Institute on Drug Abuse’s Helping to End Addiction Long-term (HEAL) initiative.

Findings from the study were published this month by JAMA Network Open.

While lower doses of buprenorphine have been recognized as the standard of care, increased doses that provide extended relief for opioid withdrawal could be helpful for patients who have been discharged from an emergency department and seek additional care.

“Once discharged, many people have difficulty linking to follow-up medical care,” study lead author Andrew A. Herring, MD, of Highland Hospital Department of Emergency Medicine, said in a news release. “Adjusting the timing and dosage of buprenorphine in the emergency department, along with resources and counseling aimed at facilitating the transition to outpatient services, may provide the momentum needed to access continuing care.” 

Researchers who worked on the study reviewed EHR data from 579 emergency department visits at Alameda Health System-Highland Hospital in Oakland, California in 2018. A total of 391 adults accounted for the ED visits, many of whom were from vulnerable populations. In 63% of cases, clinicians administered more than 12 mg of sublingual buprenorphine (the standard upper limit). Nearly a quarter of patients (23%) received 28 mg or more. Of those patients given higher doses of buprenorphine, none reported possible side effects of respiratory problems or drowsiness, and the small number of serious adverse events observed were determined to be unrelated to the high-dose regimen itself.

“Emergency departments are at the front lines of treating people with opioid use disorder and helping them overcome barriers to recovery such as withdrawal,” NIDA director Nora D. Volkow, MD, said in a statement. “Providing buprenorphine in emergency departments presents an opportunity to expand access to treatment, especially for underserved populations, by supplementing urgent care with a bridge to outpatient services that may ultimately improve long-term outcomes.”