Buprenorphine OD

[crmark]

My facts in this case come from the local ME who is a friend, and from a neonatologist-friend at the local teaching hospital who says this sort of thing (kids getting hold of bupe and presenting to ED's in varying degrees of OD) happens quite frequently and aren't reported in the press. Once again I know this is not pertaining directly to ORT patients but I feel we should, perhaps, have a healthier respect for bupe before we begin putting it in the water supply, or as I heard somewhere: the proposal to allow pharmacists, physician extenders, etc. to give it out for free. BTW, as a former practicing anesthesiologist we had more than one case of post op patients suffering respiratory depression after an IV dose of Buprenex in the RR. There are a lot of confounding factors there but I still believe respect is warranted, especially given the increasing numbers of patients I am seeing from local bupe clinics who are regularly prescribed fairly high doses of benzo's right along with their ubiquitous 16 mg daily of bupe??!!

[Dave]

I used to be a freelance writer for a local big city newspaper. I learned a journalist's ethics are a far cry from a physician's ethics. Journalists make money by creative writing, not reporting the truth and nothing but the truth.

[crmark]

The "reference" is a case report, true, in which a child died of an overdose where the tox screen showed the presence of only one substance: bupe. I clearly stated this wasn't regarding a typical patient who was being prescribed bupe for ORT. Was only countering the notion that someone could not die from "bupe alone".

Not sure why "Dave" would take such issue with such a report?

[Dave]

I would hope crmark could find better references than the Knoxville News Sentinel. One of the references above was about a mother murdering her infant. The other may have been an accidental child overdose.

It may be true that bupe can kill children without the presence of other drugs, but I have yet to see convincing proof. In any case this does not pertain to most of our patients.

[crmark]

http://www.knoxnews.com/news/crime-courts/autopsy-infant-died-of-subutex-overdose-2e143a9b-d006-5b68-e053-0100007f5dd4-372111591.html?d=mobile

http://www.knoxnews.com/news/crime-courts/study-drug-that-killed-girl-often-present-in-child-overdoses-2e1ac6ef-6332-6648-e053-0100007f9d11-372169821.html?d=mobile

Relalize this isn't referring to our actual patients but the risk of collateral damage is very real. "No deaths due to bupe alone" is an inaccurate and very misleading statement.

[Dave]

That sounds like my experience too. No deaths due to bupe alone. Discharging a patient without a very good reason may be a death sentence to that person, because they are likely to go back to street drugs.