Approach Considerations
Although widely available, drug screens rarely alter clinical management in uncomplicated buprenorphine overdoses. Drug screens are most sensitive when performed on urine. Specific assays for buprenorphine are not routinely available in the emergency department or hospital laboratory.
Confirmation of buprenorphine exposure is feasible with drug-specific radioimmunoassay, gas or liquid chromatography with mass spectroscopy, or enzyme-linked immunosorbent assay (ELISA). Quantification of buprenorphine, and its metabolite norbuprenorphine, may be performed in reference laboratories, but results likely will not return in sufficient time to impact clinical decision making. [11]
In patients with moderate-to-severe toxicity, performing the following baseline studies is appropriate:
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Complete blood cell count
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Comprehensive metabolic panel
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Creatine kinase level
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Arterial blood gas determination
Obtain chest radiographs if acute lung injury is suspected or if aspiration has possibly occurred.
An electrocardiogram should be obtained on all patients with intentional overdose to rule out effects of possible cardioactive co-ingestants (eg, tricyclic antidepressants [TCAs], Na/K/Ca/β-channel blockers).
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Dose/response (pCO2) with buprenorphine.
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Pharmacologic effects comparing a full agonist, morphine, to a partial agonist, buprenorphine.
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Demographics from a retrospective review of 86 children exposed to buprenorphine.
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Duration of clinical effects in pediatric Suboxone exposure. Adapted from Pediatrics. Apr 2008;121(4):e782-6.
