Presentation
We present a 20-year-old morphine-addicted man who presented with methadone-induced respiratory depression and responded safely and effectively to intravenous administration of buprenorphine. [ncbi.nlm.nih.gov]
Entire Body System
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Intravenous Administration
We present a 20-year-old morphine-addicted man who presented with methadone-induced respiratory depression and responded safely and effectively to intravenous administration of buprenorphine. [ncbi.nlm.nih.gov]
Naloxone has poor bioavailability in the sublingual form; therefore, buprenorphine’s effect predominates. 15, 27 However, if buprenorphine-naloxone is taken inappropriately via subcutaneous, intramuscular, or intravenous administration, sufficient naloxone [cfp.ca]
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Limb Pain
Phantom limb pain is a common consequence of limb amputation and is prevalent among the service members sustaining traumatic battlefield limb injuries during the conflicts in Iraq and Afghanistan. [ncbi.nlm.nih.gov]
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Burning Pain
Three months later, he developed constant and burning pain within the entire right side of his body. He was diagnosed with central pain syndrome and treated with antiepileptics and tricyclic antidepressants. [ncbi.nlm.nih.gov]
Skin
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Cutaneous Manifestation
[…] i.v. buprenorphine hydrochloride (Subutex) misuse has been creating a number of medical complications, and cutaneous manifestations such as soft tissue infection are one of the commonest consequences. [ncbi.nlm.nih.gov]
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Formication
The HPLC mobile phase (0.25 ml/min) was 0.1% formic acid in water (A) and 0.1% formic acid in acetonitrile (B). [doi.org]
Psychiatrical
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Depersonalization
Kappa receptor activation produces analgesia, miosis, sedation, dysphoria and psychotomimetic effects including disorientation and/or depersonalization. [federalregister.gov]
[…] injury, affect lability, agitation, alanine aminotransferase increased, angina pectoris, angioedema, apathy, application site dermatitis, asthma aggravated, bradycardia, chills, confusional state, contact dermatitis, coordination abnormal, dehydration, depersonalization [app.purduepharma.com]
Urogenital
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Urethral Discharge
The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. [ncbi.nlm.nih.gov]
Neurologic
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Altered Mental Status
In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic [ncbi.nlm.nih.gov]
Workup
Microbiology
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Staphylococcus Aureus
Tissue and blood culture were positive in 19 (42%) patients and Methicillin-sensitive Staphylococcus aureus was the commonest microbiological isolate (20%). [ncbi.nlm.nih.gov]
Treatment
PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. [ncbi.nlm.nih.gov]
[…] period of treatment. [doi.org]
2 1 Completed Treatment Opioid-use Disorder 1 1 Completed Treatment Osteoarthritis Disorders 1 1 Completed Treatment Pain NOS 2 1 Completed Treatment Substance-Related Disorders 1 1 Not Yet Recruiting Treatment Postoperative pain 1 1 Recruiting Basic [drugbank.ca]
“As part of our ongoing work in supporting the treatment of those suffering from addiction to opioids, the FDA plans to issue guidance to expedite the development of new addiction treatment options. [fda.gov]
Entry into buprenorphine treatment (PDF 225 KB) 3. Guidelines for maintenance treatment (PDF 400 KB) 4. Guidelines for the management of heroin withdrawal (PDF 327 KB) 5. Complications or adverse events with buprenorphine treatment (PDF 281 KB) 6. [nationaldrugstrategy.gov.au]
Etiology
Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management. [ncbi.nlm.nih.gov]
Epidemiology
Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. [ncbi.nlm.nih.gov]
Levels of evidence Level I: At least one properly conducted randomized controlled trial, systematic review, or meta-analysis Level II: Other comparison trials, non-randomized, cohort, case-control, or epidemiologic studies, and preferably more than one [cfp.ca]
Ritchie, Pain Behind Bars: The Epidemiology of Pain in Older Jail Inmates in a County Jail, Journal of Palliative Medicine, 17, 12, (1336), (2014). P. D. MacFarlane, A. S. Tute and B. [doi.org]
Report of the Asian Multi-city Epidemiological Workgroup. Eds. Navaratnam, V. and Bakar, A.A. 144-50. Coggans, N., Shewan, D., Henderson, M; Davies, J.B. (1991). The impact of school-based drug education. Br J Addict. 86:1099-1109. [federalregister.gov]
Pathophysiology
By evaluating the pharmacological characteristics of this substance, as well as the data previously published in the literature, we have attempted to explain the pathophysiological mechanisms of this particular mode of poisoning that can easily be fatal [ncbi.nlm.nih.gov]
‡ Research Fellow, # Professor, Institute of Physiology and Pathophysiology, Friedrich-Alexander-University Erlangen-Nuremberg. [doi.org]
Prevention
The high affinity also prevents binding of other opioids, at commonly used clinical doses, to receptor sites - preventing their analgesic and likely minimum alveolar concentration (MAC) reducing benefits. [ncbi.nlm.nih.gov]
Severe withdrawal side effects can usually be prevented when a person is switched to buprenorphine and naloxone combination. It acts on the central nervous system (CNS) to help prevent the withdrawal side effects. [mayoclinic.org]