Fatal Poisoning in Methadone and Buprenorphine Treated Patients - Are there Differences?

Soyka, Michael; Penning, R.; Wittchen, U.

doi:10.1055/s-2006-941482

Cited by 22 publications

(13 citation statements)

References 16 publications

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“…These data are consistent with other findings, especially French and German forensic autopsy data that indicate a low mortality risk with buprenorphine [145,146]. Bell et al [7] reported that buprenorphine may be safer in the induction phase.…”

Section: Risk Of Fatal Poisoning/mortalitysupporting

confidence: 90%

Buprenorphine Use and Risk of Abuse and Diversion

Soyka¹

2014

Adv Pharmacoepidem Drug Safety

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Buprenorphine in Opioid Maintenance Treatment: A Brief UpdateBuprenorphine is an established first-line medication for the treatment of opioid dependence (see APA guidelines [24] AbstractOpioid maintenance therapy with methadone or buprenorphine is a well-established first-line treatment for opioid dependence. However, risk of diversion and drug-related mortality are critical issues during maintenance therapy. These issues are discussed controversially in both the scientific and public arenas and are a matter of concern also among medical authorities. In addition to a formulation containing buprenorphine alone, a combination formulation with buprenorphine and naloxone in a 4:1 ratio is available. The combination formulation was developed with the aim to prevent intravenous use or diversion. This critical review summarizes data on the risk of abuse and diversion of buprenorphine.

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Section: Risk Of Fatal Poisoning/mortalitysupporting

confidence: 90%

Buprenorphine Use and Risk of Abuse and Diversion

Soyka¹

2014

Adv Pharmacoepidem Drug Safety

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“…In France, buprenorphine is far more frequently used than methadone, 37 whereas the number of deaths associated with buprenorphine and methadone are rather equal. 38 Recent data from forensic autopsy material from the upper Bavarian region point into the same direction 39 and indicate a lower rate of fatal intoxications associated with buprenorphine. These findings may be explained by differential use of both drugs.…”

Section: Discussionmentioning

confidence: 88%

One-year Mortality Rates of Patients Receiving Methadone and Buprenorphine Maintenance Therapy

Soyka¹,

Apelt²,

Lieb³

et al. 2006

Journal of Clinical Psychopharmacology

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Mortality rates in drug-dependent patients in substitution treatment remain a matter of debate. Although several retrospective toxicological or forensic postmortem studies on this issue have been conducted, few prospective studies have addressed this problem. In a nationally representative sample of 2694 opioid dependent patients in substitution treatment either with methadone or buprenorphine at baseline were monitored over a 12-month period (response rate, 91%). A total number of 1629 (60.4%) were still in treatment after 12 months. The overall mortality rate was 1.04%. In total, 28 patients of the initial sample deceased within the 1-year follow-up period. Eleven (0.4%) of these deaths are due to a fatal intoxication. Three patients (0.1%) died of human immunodeficiency virus/acquired immunodeficiency syndrome, and 3 (0.1%) committed suicide. Thirteen of these patients (4 with overdose/polyintoxication) were not in substitution treatment at the time of death. Other reasons included accidents and deaths due to other medical conditions. Only in one case the reason could not be ascertained. The mortality rate was similar in methadone as compared with buprenorphine patients. Taking into account the high comorbidity of opioid dependent patients and the severity of dependence, the mortality rate of approximately 1% confirms that maintenance treatment could be regarded as a fairly safe treatment.

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“…This has been shown in animal studies [2]. Still, there are several reports on buprenorphine related deaths that points in another direction and many of these cases present with buprenorphine concentrations in the therapeutic range [3][4][5][6][7][8][9][10][11]. A compilation of buprenorphine concentrations from earlier publications is presented in Table 1.…”

mentioning

confidence: 84%

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

Seldén

Ahlner

Druid

et al. 2012

Forensic Science International

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Fatal Poisoning in Methadone and Buprenorphine Treated Patients - Are there Differences?

Abstract: More prospective studies are necessary to assess the risk of fatal intoxications under different substitution regimens.

Cited by 22 publications

References 16 publications

Buprenorphine Use and Risk of Abuse and Diversion

Buprenorphine Use and Risk of Abuse and Diversion

One-year Mortality Rates of Patients Receiving Methadone and Buprenorphine Maintenance Therapy

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

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