Buprenorphine/Naloxone Toxicity Workup

Updated: Dec 29, 2015
  • Author: Timothy J Wiegand, MD; Chief Editor: Asim Tarabar, MD  more...
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Workup

Laboratory Studies

Although widely available, drug screens in uncomplicated overdoses rarely alter clinical management. 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 baseline studies, including a CBC, comprehensive metabolic panel, creatine kinase level, and arterial blood gas determination, is appropriate.

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Imaging Studies

Obtain chest radiographs if acute lung injury is suspected or if aspiration has possibly occurred.

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Other Tests

An ECG 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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