- Buprenorphine found to have low risk of producing withdrawal symptoms
- Is highly effective treatment for opioid use disorder
The impact of opioids in Canada is clear with an average of 22 people dying daily from overdoses. For those who do survive, withdrawal symptoms are a major problem to overcoming addiction.
Now, a review led by University of Ottawa researchers has found a commonly used drug to treat opioid addiction has low withdrawal effects and should not be a barrier to use despite currently being under prescribed.
Like methadone, buprenorphine is an evidence-based treatment for opioid use that has been shown to be effective in reducing opioid consumption, reducing return visits to emergency departments (78 per day) and hospitalizations (17/day), and reducing overall mortality. Though it is accessible to Canadians, less than 1 percent of patients are prescribed it because of concerns it can cause precipitated withdrawal', in which the first dose causes sudden, intense pain and anxiety.
But a new systematic review published in Addiction and led by Dr. Debra Eagles, an Associate Professor, Department of Emergency Medicine at the University of Ottawa and Dr. Caroline Gregory an emergency medicine resident, has found the incidence of precipitated withdrawal adults with opioid use disorder is low when taking their first dose, with symptoms generally mild.
"This study will hopefully ease some of the fear of using buprenorphine and provide information for patients and providers when discussing buprenorphine initiation since it is the first systematic review to show the overall incidence of precipitated withdrawal is low," says principal author Dr. Gregory of the Department of Emergency Medicine at the Faculty of Medicine.
The team reviewed 26 studies of buprenorphine-precipitated withdrawal, including five randomized trials, all conducted between 2002 and 2023 and with a total sample size of 4,497 patients. They found room for improvement as the overall quality of the studies included in this review was poor and there is no standard definition of precipitated withdrawal. Even so, the highest-quality studies to date have consistently found low rates of precipitated withdrawal, including in fentanyl.
"This will hopefully help ease some of the fear of using buprenorphine but, ultimately, it is important for future research to examine the risk of precipitated withdrawal specifically in people who use fentanyl," adds Dr. Gregory. "But, until those high-quality studies are conducted, doctors and patients should not resist using this highly effective treatment for opioid use disorder."
