Abruptly Discontinuing Buprenorphine Therapy For Opioid Overdose Can Be 'Life-Threatening'

Despite being effective in pain management, the use of opioids becomes a problem when people continue to take them in spite of negative resulting consequences. With more than 2 million Americans with Opioid Use Disorder (OUD), the number of illicit drugs and prescription opioids has also been on the rise.

Also, in 2017, more than 72,000 Americans died due to opioid overdose, making it a nationwide public health emergency.

Buprenorphine is one of the FDA-approved drugs that have been used to treat opioid addiction. The drug acts by blocking the effects of other opioids and reduces or eliminates withdrawal symptoms alongside reducing opioid craving. However, the drug is provided only by trained physicians, nurse practitioners and physician assistants in office-based settings.

A recent study has reported that OUD patients are at high risk of overdose even after 18 months of treatment with buprenorphine. They found that about 5% of individuals who took buprenorphine were treated for an opioid overdose within 6 months of discontinuing the drug. But the actual rate is likely to be higher, the researchers said they were unable to include patients who overdosed but never showed up for treatment.

“The rate at which individuals relapsed and overdosed after ending treatment was alarmingly high, suggesting that discontinuing buprenorphine is a life-threatening event. Because of this risk, retention on buprenorphine in this population is of the utmost importance," Medscape Medical News quoted the study’s lead author Arthur Robin Williams, MD, Assistant Professor of clinical psychiatry at Columbia University and a research scientist at New York State Psychiatric Institute, New York City.

The study took into account 8996 adult Medicaid recipients who were under buprenorphine therapy for a minimum of 6 months and maintained their Medicaid enrollment even 6 months after discontinuing the treatment. The findings of their investigation reported that compared to those who took the treatment for 15-18 months had significantly reduced rates of emergency department visits compared to those who stopped taking the drug after 6-9 months. They also had lesser opioid prescription fills.

It is unclear from the research why discontinuing the drug happens, but factors like stigma might contribute to it. Due to the lack of adequate research, the optimal duration of buprenorphine therapy remains unclear. However, the researchers feel that ‘longer is better’ and that in general, the expert consensus is about 1-2 years.