Case Report: Buprenorphine Induction Using Transdermal Buprenorphine in a Veteran With Opioid Use Disorder and Psychosis, Managing Precipitated Withdrawal
Open Access
- 21 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Military Medicine
- Vol. 185 (9-10), e1872-e1875
- https://doi.org/10.1093/milmed/usaa068
Abstract
Buprenorphine induction can lead to precipitated opioid withdrawal, even when using novel techniques such as transdermal buprenorphine. Involuntary limb movements are a distressing symptom of precipitated withdrawal that can be difficult to treat. We report a case of a military veteran transitioning from methadone to buprenorphine for the treatment of opioid use disorder (OUD) using small doses of transdermal buprenorphine. Herein, we review the literature associated with opioid withdrawal-related restlessness. Despite the known risk of concurrent benzodiazepine and buprenorphine administration, including decreased respiratory rate and death, we present a clinical presentation in which this medication combination may be necessary while under medical supervision. We suggest a stepwise algorithm for pharmacotherapy in patients experiencing involuntary limb movements associated with precipitated withdrawal. To safeguard the success of medication-assisted treatment (MAT) for opioid addiction, clinicians should be aware of potential clinical challenges when managing precipitated opioid withdrawal in patients with complex psychiatric comorbidities.Keywords
This publication has 18 references indexed in Scilit:
- Transitioning Hospitalized Patients with Opioid Use Disorder from Methadone to Buprenorphine without a Period of Opioid Abstinence Using a Microdosing ProtocolPharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2019
- Transdermal buprenorphine patch: Potential for role in management of opioid dependenceAsian Journal of Psychiatry, 2019
- Prevalence of restless legs syndrome during detoxification from alcohol and opioidsJournal of Substance Abuse Treatment, 2016
- Transdermal Buprenorphine, Opioid Rotation to Sublingual Buprenorphine, and the Avoidance of Precipitated WithdrawalClinical Journal of Sport Medicine, 2015
- Restless Legs Syndrome: Pathophysiology and TreatmentCurrent Treatment Options in Neurology, 2014
- Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worldsJournal of Neurosciences in Rural Practice, 2012
- The Clinical Opiate Withdrawal Scale (COWS)Journal of Psychoactive Drugs, 2003
- The clinical pharmacology of buprenorphine: extrapolating from the laboratory to the clinicDrug and Alcohol Dependence, 2003
- Transient Restless Legs-like Syndrome as a Complication of Opiate WithrawalPharmacopsychiatry, 2003
- Effects of buprenorphine and methadone in methadone-maintained subjectsPsychopharmacology, 1995