Parenteral Buprenorphine for Opioid Withdrawal: A Case Series

Buprenorphine is the standard of care for the treatment of opioid withdrawal. However, when sublingual (SL) administration is not appropriate or practical, parenteral administration by the intravenous (IV) or intramuscular (IM) route may be a reasonable substitute. Although buprenorphine was previously used intravenously for the treatment of pain, current practitioners have limited experience with its parenteral use.

This is a case series using a retrospective chart review of patients at an urban public hospital who received IV or IM buprenorphine for the treatment of opioid withdrawal. A query of the electronic health record was performed to identify patients who had received IV or IM buprenorphine from January 2020 to December 2021. Charts were reviewed for patient demographics, medical history, substance use history, urine drug screens, clinical scenario, indication for parenteral buprenorphine, dose of buprenorphine, vital sign trends, and any measure of change in withdrawal.

Eight patients were identified. The most frequent initial dose of parenteral buprenorphine was 0.3 mg, and if buprenorphine needed to be re-dosed, it was most commonly administered every 6 hours. The most common indications for use were delirium or intractable nausea and vomiting related to opioid withdrawal. Withdrawal improved in six of the eight cases and often allowed for subsequent use of SL buprenorphine. There were no adverse effects identified.

Parenteral buprenorphine was successfully used to treat opioid withdrawal in a select group of patients. Further studies are needed to identify the optimal use parameters of parenteral buprenorphine.