BUPRENORPHINE POISONING IN DRUG-ABUSERS O N SUBSTITUTION THERAPY - 29NONFATAL AND 20 FATAL CASES

OBJECTIVES: Buprenorphine has been an important advance in care for dr ug abusers, but the toxic risk may be fetal. We report here two origin al series of buprenorphine poisoning in opiate abusers on substitution therapy. PATIENTS: The first series included 20 males and 9 females, aged 20-35 years (mean=27.5) with non-fetal poisoning. The second seri es included 20 subjects (19 males, 1 female) aged 14-48 years (mean=26 .6) with a fetal outcome. All subjects were opiate addicts taking high -dosage sublingual buprenorphine formulation as substitution therapy. RESULTS: Blood concentrations of buprenorphine were found in all cases to remain at a low level (1.0-2.3 ng/ml, m = 1.4 ng/ml, and 1.1-29.0 ng/ml, m=8.4 ng/ml in non-fatal and fatal cases respectively). Almost all cases involved concomitant intake of psychotropic medications, esp ecially benzodiazepines (18 non-fetal and 17 fetal cases). DISCUSSION: These observations confirm previously reported data on the danger of buprenorphine-benzodiazepine combinations. Intravenous injection of cr ushed tablets also appears to be a risk factor (8 deaths and 10 non-fa tal poisonings). This series highlights the need for improvement in th e recently developed French program for substitution therapy with high -dosage buprenorphine in heroin addicts.