Buprenorphine, Polydrug Use and Deaths

Abstract

Buprenorphine is an opioid analgesic and a medication used for opioid agonist treatment.Being a partial mu-opioid receptor agonist, it has a greater margin of safety compared to full agonists. Despite the relative safety of buprenorphine, the concomitant use of central nervous system depressant drugs is associated with an increased risk of respiratory depression, intoxication and death. Injection of buprenorphine and polydrug use are major mortality risk factors. Clonazepam, alprazolam, diazepam, pregabalin and alcohol are particularly often associated with fatal poisonings. An established user does not favour buprenorphine because of its euphoric effect, but the drug is rather used to manage opioid withdrawal symptoms, while concomitant sedative-hypnotic or illicit drugs may be taken to obtain or augment the opioid high. Perceived underdosing of buprenorphine in opioid agonist treatment is one reason for polydrug use. Prevention measures include encouraging safer consumption habits such as avoiding injection, as well as efforts to reduce concomitant use of alcohol, sedative-hypnotic drugs, and illicit drugs among buprenorphine users.