Escalating Doses of Buprenorphine for the Treatment of Buprenorphine-Induced Opioid Withdrawal

Abstract

This report outlines a case of opiate withdrawal that occurred following the initiation of treatment for opioid use disorder (OUD) with buprenorphine. Buprenorphine is a novel drug that is used in the treatment of OUD and is incredibly effective in doing so. However, a rare and paradoxical effect can occur when treatment is initiated with buprenorphine, where the drug, due to its unusual mechanism of action, precipitates withdrawal. Most of the time, withdrawal can be treated with supportive therapy. However, there is growing evidence in the literature that withdrawals precipitated by buprenorphine can and should be treated with increased doses of buprenorphine. This case is an example of this exact phenomenon. In this case, our patient had a longstanding OUD, particularly fentanyl use, which was treated the day of presentation with the initiation of buprenorphine. She later presented to the emergency department in opioid withdrawal, which was treated with adjunct therapy that did not aid in the resolution of symptoms. Finally, escalating doses of buprenorphine were administered, which resolved the patient's symptoms, highlighting another case to be added to the growing evidence that opioid withdrawals precipitated by buprenorphine can and should be treated with escalating doses of buprenorphine.

Keywords: buprenorphine; opiate withdrawal; opioid withdrawals; pain management; suboxone.