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Postpartum Extended-Release Buprenorphine Tissue Necrosis.

Theresa Kurtz1, Jasmin E Charles, Megan Schwartz

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Tissue necrosis is a rare complication of extended-release buprenorphine (XRB) injections in postpartum individuals. Proper subcutaneous injection technique can prevent this issue, and patients can often continue treatment without recurrence.

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Area of Science:

  • Obstetrics and Gynecology
  • Addiction Medicine
  • Pharmacology

Background:

  • Extended-release buprenorphine (XRB) shows promise for opioid use disorder (OUD) treatment in postpartum individuals.
  • Obstetric clinicians possess limited experience with XRB, necessitating guidance on its use and potential complications.

Purpose of the Study:

  • To describe two cases of tissue necrosis associated with XRB injections in postpartum patients.
  • To highlight recommended injection techniques and management strategies for XRB-related tissue necrosis.

Main Methods:

  • Case report of two postpartum individuals experiencing tissue necrosis following XRB administration.
  • Review of injection technique (intradermal vs. subcutaneous) and subsequent wound management.

Main Results:

  • Two postpartum patients developed tissue necrosis, one after initial injection and another during long-term treatment.
  • Both cases were attributed to incorrect intradermal injection instead of the recommended subcutaneous technique.
  • Neither patient experienced recurrence after appropriate management and continuation of monthly XRB, indicating the complication is not allergic.

Conclusions:

  • Tissue necrosis is a rare but manageable complication of extended-release buprenorphine injections.
  • Clinicians must be trained in proper subcutaneous injection techniques to prevent this adverse event.
  • Early recognition and appropriate management allow for continued successful treatment with XRB.