Podcast # 491: Buprenorphine for Withdrawal

Buprenorphine is a semi-synthetic derivative of the opium poppy

FDA approved for the treatment of opiate use disorder and chronic pain

Benefit in emergency department use is the ceiling effect - producing less euphoria as well as respiratory depression with higher doses

It has an onset of 30-60 minutes, peak effect at 1-4 hours

Duration of action depends is dose dependent, typically 6-12 hours, but can be as long as 24-72 hours in doses over 16 mg

Use buprenorphine in those in moderate to severe opiate withdrawal

Clinical Opioid Withdrawal Scale (COWS) can be used to assess and score severity of withdrawal

A reasonable starting dose is 8mg. A second dose can be given after an hour, ranging from 8-24 mg depending on symptoms still present

Buprenorphine can induce withdrawals so someone needs to be in true withdrawals for it to provide benefit