Educational Pearls:

• Buprenorphine is a semi-synthetic derivative of the opium poppy
• FDA approved for the treatment of opiate use disorder and chronic pain
• Benefit in emergency department use is the ceiling effect - producing less euphoria as well as respiratory depression with higher doses
• It has an onset of 30-60 minutes, peak effect at 1-4 hours
• Duration of action depends is dose dependent, typically 6-12 hours, but can be as long as 24-72 hours in doses over 16 mg
• Use buprenorphine in those in moderate to severe opiate withdrawal
• Clinical Opioid Withdrawal Scale (COWS) can be used to assess and score severity of withdrawal
• A reasonable starting dose is 8mg. A second dose can be given after an hour, ranging from 8-24 mg depending on symptoms still present
• Buprenorphine can induce withdrawals so someone needs to be in true withdrawals for it to provide benefit

References

https://www.mdcalc.com/cows-score-opiate-withdrawal

https://ed-bridge.org

Herring AA, Perrone J, Nelson LS. Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. Ann Emerg Med. 2019 May;73(5):481-487. doi: 10.1016/j.annemergmed.2018.11.032. Epub 2019 Jan 5. Review. PubMed PMID: 30616926.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD