Buprenorphine Overdose in Young Children: An Underappreciated Risk

The escalation of the opioid crisis has led to an increase in the treatment of opioid use disorder. In particular, recent legislation has allowed for office-based treatment with buprenorphine, a partial µ-opioid agonist that is believed to be safer than methadone due to a ceiling effect on respiratory depression in adults. An increasing number of children are being exposed to buprenorphine as more adults in US households receive take-home prescriptions. The ceiling effect seen in adults does not seem to apply to young children, and intoxication with severe symptoms including fatalities can occur. This article outlines the pharmacology of buprenorphine and reviews the current literature on overdose in children. We conclude with practical recommendations for limiting potential exposure and damage to children from accidental buprenorphine overdose.