Oral cavity cancer after sublingual buprenorphine use

The most widely utilized formulations of buprenorphine to treat opioid use disorder (OUD) are sublingual tablets or films. In 2022, the FDA issued a safety communication regarding reports of dental diseases associated with orally dissolvable buprenorphine. However, an association of sublingual buprenorphine with oral cavity malignancy has not been previously described. Here, we present a case report of a 53-year-old female with no history of tobacco use who developed a sublingual oral cavity squamous cell carcinoma (OCSCC) in the same location where she had placed sublingual buprenorphine for 13 years. The patient was successfully treated with surgery, with final pathologic staging of pT1N0. To our knowledge, this is the first report of oral cavity malignancy associated with sublingual buprenorphine use, however there is mechanistic and circumstantial rationale in this case to suggest a possible causative role of sublingual buprenorphine. The objective of this case report is to alert both oral cancer and OUD care providers of a possible risk association that may warrant further investigation should additional cases emerge.