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High-Dose Buprenorphine Initiation: A Scoping Review.
Stanley Wong1, Nicholas Fabiano, Declan Webber
1From the Department of Psychiatry, University of Toronto, Toronto, Canada (SW, RAK); Centre for Addiction and Mental Health, Toronto, Canada (RAK); Department of Psychiatry, University of Ottawa, Ottawa, Canada (NF); and Department of Family and Community Medicine, University of Toronto, Toronto, Canada (DC).
Journal of Addiction Medicine
|May 17, 2024
Summary
High-dose buprenorphine initiation, exceeding 12 mg, shows no reported overdose or respiratory depression cases. However, limited data necessitates further research into its safety and effectiveness.
Area of Science:
- Pharmacology
- Addiction Medicine
- Clinical Research
Background:
- High-dose buprenorphine initiation (>12 mg) is an emerging strategy for opioid use disorder treatment.
- Understanding the safety and efficacy of this approach is crucial for clinical practice.
Purpose of the Study:
- To review and synthesize existing literature on high-dose buprenorphine initiation.
- To identify reported outcomes, adverse events, and limitations in current research.
Main Methods:
- A comprehensive scoping review of multiple databases (MEDLINE, Embase, PsycINFO, Cochrane Central) was performed.
- Included studies published in English before February 13, 2023, encompassing RCTs, cohort studies, and case reports.
Main Results:
- Fifteen studies involving 580 high-dose buprenorphine initiations were analyzed across various settings.
- No fatal or nonfatal overdose or respiratory depression events were reported.
- Common side effects included nausea/vomiting and precipitated withdrawal; serious events were rare (e.g., hypotension).
Conclusions:
- High-dose buprenorphine initiation appears safe regarding overdose and respiratory depression based on current literature.
- Limitations include inconsistent adverse event reporting, limited follow-up, and lack of comparative data.
- Further prospective studies are required to fully assess the safety and effectiveness of high-dose buprenorphine initiation.
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