Neil B Varshneya1, Ashish P Thakrar, J Gregory Hobelmann, Kelly E Dunn, Andrew S Huhn. 1. From the Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (NBV, JGH, KED, ASH); National Clinician Scholars Program at the Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, Philadelphia, PA (APT); Ashley Addiction Treatment, Havre de Grace, MD (JGH, ASH).
Abstract
OBJECTIVES: Buprenorphine can precipitate withdrawal in opioid-dependent persons with recent fentanyl use. However, the prevalence of this phenomenon is not clinically established. We sought to evaluate the incidence of buprenorphine-precipitated withdrawal in persons who use fentanyl. METHODS: We collected self-report data on opioid withdrawal symptoms after buprenorphine use, and, as a comparator, after methadone use, in 1679 individuals seeking treatment for opioid use disorder across 49 addiction treatment centers in the United States. RESULTS: The odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use (OR = 5.202, 95% CI = 1.979-13.675, P = 0.001), and within 24 to 48hours after fentanyl use (OR = 3.352, 95% CI =1.237-9.089, P = 0.017). As expected, patients did not report significantly higher rates of withdrawal when taking methadone after fentanyl use. Of those who waited less than 24hours after fentanyl before using buprenorphine or methadone, 22.19% (n = 152 of 685) and 11.56% (n = 23 of 199), respectively, reported severe opioid withdrawal. CONCLUSIONS: This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies.
OBJECTIVES: Buprenorphine can precipitate withdrawal in opioid-dependent persons with recent fentanyl use. However, the prevalence of this phenomenon is not clinically established. We sought to evaluate the incidence of buprenorphine-precipitated withdrawal in persons who use fentanyl. METHODS: We collected self-report data on opioid withdrawal symptoms after buprenorphine use, and, as a comparator, after methadone use, in 1679 individuals seeking treatment for opioid use disorder across 49 addiction treatment centers in the United States. RESULTS: The odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use (OR = 5.202, 95% CI = 1.979-13.675, P = 0.001), and within 24 to 48hours after fentanyl use (OR = 3.352, 95% CI =1.237-9.089, P = 0.017). As expected, patients did not report significantly higher rates of withdrawal when taking methadone after fentanyl use. Of those who waited less than 24hours after fentanyl before using buprenorphine or methadone, 22.19% (n = 152 of 685) and 11.56% (n = 23 of 199), respectively, reported severe opioid withdrawal. CONCLUSIONS: This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies.
Authors: Denis Antoine; Andrew S Huhn; Eric C Strain; Gavin Turner; Jasmyne Jardot; Alexis S Hammond; Kelly E Dunn Journal: Am J Addict Date: 2020-06-23
Authors: Chelsea L Shover; Titilola O Falasinnu; Candice L Dwyer; Nayelie Benitez Santos; Nicole J Cunningham; Rohan B Freedman; Noel A Vest; Keith Humphreys Journal: Drug Alcohol Depend Date: 2020-09-28 Impact factor: 4.492
Authors: Elizabeth M Schoenfeld; Lauren M Westafer; Samantha A Beck; Benjamin G Potee; Sravanthi Vysetty; Caty Simon; Jillian M Tozloski; Abigail L Girardin; William E Soares Journal: Acad Emerg Med Date: 2022-05-16 Impact factor: 5.221
Authors: Jessica Heil; Valerie S Ganetsky; Matthew S Salzman; Krystal Hunter; Kaitlan E Baston; Gerard Carroll; Eric Ketcham; Rachel Haroz Journal: West J Emerg Med Date: 2022-04-04