Opioid overdose reduced in patients taking buprenorphine


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IMAGE: Laura Bierut was one of many senior investigators who studied buprenorphine therapy for opioid use dysfunction in sufferers who additionally take benzodiazepines — medicine that deal with anxiousness and comparable circumstances….
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Credit score: Washington College

Even in the course of the COVID-19 pandemic, opioid misuse has continued unabated in america, with an estimated 2.5 million or extra People affected by opioid use dysfunction. Most individuals handled for the dysfunction are given medicines, equivalent to buprenorphine, that activate opioid receptors. However there may be disagreement about whether or not it is protected to prescribe buprenorphine for individuals who additionally take benzodiazepines, that are probably addictive medicines prescribed for stress, sleep and anxiousness.

New analysis involving the medical knowledge of greater than 23,000 sufferers being handled for opioid use dysfunction helps the usage of buprenorphine in sufferers additionally taking benzodiazepines. Researchers at Washington College Faculty of Medication in St. Louis discovered that the drug can shield opioid customers from overdosing, even when such sufferers additionally take benzodiazepines, equivalent to Valium, Xanax and Ativan.

The examine is revealed on-line March 3 in The American Journal of Psychiatry.

“Buprenorphine has had excellent outcomes as a therapy for opioid use dysfunction, partly as a result of sufferers can take the drug at residence, which is completely different from different medicine generally used to deal with the dysfunction equivalent to methadone, which requires visits to clinics,” stated first writer Kevin Xu, MD, a resident doctor within the Division of Psychiatry. “It is well-known that buprenorphine saves lives in sufferers with opioid use dysfunction, however as a result of the drug has central nervous system miserable results, there have been massive questions on security when sufferers additionally take benzodiazepines, which additionally depress the central nervous system. Our findings, nevertheless, point out that buprenorphine makes overdose much less seemingly, even in individuals additionally taking benzodiazepines.”

The analysis group dug into the subject partly as a result of many therapy facilities don’t settle for sufferers who’re hooked on opioids and likewise take prescription benzodiazepines.

“As much as a 3rd of people that endure opioid overdoses even have benzodiazepines of their programs,” Xu stated. “Many individuals get turned away from buprenorphine therapy or, even worse, their medical doctors abruptly taper them off benzodiazepines, which will be very destabilizing. Our aim was to study extra about whether or not there are risks related to taking buprenorphine whereas additionally taking benzodiazepines.”

Though buprenorphine is not the one medicine used to deal with opioid use dysfunction — others embody methadone and naltrexone — the researchers targeted on buprenorphine on this examine as a result of sufferers typically can fill prescriptions for the medicine at a pharmacy and take the drug at residence.

Xu and his colleagues — together with Laura J. Bierut, MD, the Alumni Endowed Professor of Psychiatry, and Richard A. Grucza, PhD, a professor within the Division of Household and Neighborhood Medication at Saint Louis College — analyzed knowledge compiled by insurance coverage corporations that tracked emergency room visits involving 23,036 de-identified sufferers with buprenorphine prescriptions.

“We have all heard concerning the devastation attributable to opioids equivalent to heroin and fentanyl, however use of benzodiazepines additionally will be addictive and lethal,” stated Bierut, one of many examine’s senior investigators. “Many people who find themselves hooked on opioids even have anxiousness or despair for which they have been prescribed a benzodiazepine drug. The best way to deal with that mixture has confounded psychiatrists and dependancy medication specialists, however we expect these findings present some readability.”

Each de-identified affected person tracked within the database had skilled at the least one overdose occasion, however none suffered a deadly overdose. Every particular person was adopted for 2 years to trace what prescriptions they crammed and the way typically every individual ended up within the emergency division with a drug-related poisoning. Though the database tracked solely nonfatal overdoses, Xu defined these occasions account for the overwhelming majority of drug-related poisonings, including that those that endure nonfatal overdoses are in danger to finally die of a drug overdose.

“These are high-risk sufferers, and we all know that when somebody overdoses as soon as, it is seemingly she or he can be again in an emergency division once more for a similar cause,” Xu stated.

In attempting to study whether or not buprenorphine helped stop overdoses and whether or not taking that drug together with benzodiazepines may enhance overdose danger, the researchers found that opioid customers who took buprenorphine had a 40% discount of their danger for an overdose in contrast with not receiving the therapy. In the meantime, opioid customers with benzodiazepine prescriptions who didn’t take buprenorphine had been virtually twice as prone to endure an overdose that put them within the hospital.

“Even for individuals taking benzodiazepines, buprenorphine had a protecting impact,” Xu stated. “Buprenorphine did not shield these sufferers from overdose as a lot because it protected customers not taking benzodiazepines, but it surely nonetheless made overdoses much less seemingly.”

What meaning about drug interactions between buprenorphine, opioids and benzodiazepines nonetheless is not utterly clear. However what is obvious, Xu stated, is that prescribing buprenorphine for opioid customers in therapy can shield them from overdose, even when in addition they are taking a benzodiazepine drug.

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Xu Okay, Borodovsky J, Presnall N, Mintz C, Hartz S, Bierut LJ, Grucza RA. The affiliation between benzodiazepine and Z drug prescriptions and drug-related poisonings amongst sufferers receiving buprenorphine upkeep: a case-crossover evaluation. The American Journal of Psychiatry, revealed on-line March 3, 2021.

This work was supported by the Nationwide Institute of Psychological Well being, the Nationwide Institute on Alcohol Abuse and Alcoholism, the Nationwide Institute on Drug Abuse and the Nationwide Heart for Advancing Translational Sciences of the Nationwide Institutes of Well being (NIH). Grant numbers R25 MH112473-01, R21 AA024888-01, UL1 TR002345, R21 DA044744, U10 AA008401, R01 DA036583, K12 DA041449, R21 AA02568901, F32 AA027941, R24 HS19455. Extra help from the Heart for Administrative Knowledge Analysis (CADR) at Washington College.

Washington College Faculty of Medication’s 1,500 college physicians are also the medical employees of Barnes-Jewish and St. Louis Youngsters’s hospitals. The Faculty of Medication is a pacesetter in medical analysis, instructing and affected person care, rating among the many high 10 medical colleges within the nation by U.S. Information & World Report. By its affiliations with Barnes-Jewish and St. Louis Youngsters’s hospitals, the Faculty of Medication is linked to BJC HealthCare.



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