Laxton Steven J
Department of Emergency Medicine, University of Tennessee Health Science Center (UTHSC) Nashville, Saint Thomas Health, Murfreesboro, USA.
Cureus. 2025 Mar 13;17(3):e80527. doi: 10.7759/cureus.80527. eCollection 2025 Mar.
This report outlines a case of opiate withdrawal that occurred following the initiation of treatment for opioid use disorder (OUD) with buprenorphine. Buprenorphine is a novel drug that is used in the treatment of OUD and is incredibly effective in doing so. However, a rare and paradoxical effect can occur when treatment is initiated with buprenorphine, where the drug, due to its unusual mechanism of action, precipitates withdrawal. Most of the time, withdrawal can be treated with supportive therapy. However, there is growing evidence in the literature that withdrawals precipitated by buprenorphine can and should be treated with increased doses of buprenorphine. This case is an example of this exact phenomenon. In this case, our patient had a longstanding OUD, particularly fentanyl use, which was treated the day of presentation with the initiation of buprenorphine. She later presented to the emergency department in opioid withdrawal, which was treated with adjunct therapy that did not aid in the resolution of symptoms. Finally, escalating doses of buprenorphine were administered, which resolved the patient's symptoms, highlighting another case to be added to the growing evidence that opioid withdrawals precipitated by buprenorphine can and should be treated with escalating doses of buprenorphine.
本报告概述了一例在使用丁丙诺啡治疗阿片类物质使用障碍（OUD）开始后发生的阿片类物质戒断病例。丁丙诺啡是一种用于治疗OUD的新型药物，在这方面非常有效。然而，在开始使用丁丙诺啡治疗时，可能会出现一种罕见且矛盾的效应，即由于其独特的作用机制，该药物会引发戒断反应。大多数情况下，戒断反应可用支持性疗法治疗。然而，文献中有越来越多的证据表明，由丁丙诺啡引发的戒断反应可以且应该用增加剂量的丁丙诺啡来治疗。本病例就是这一确切现象的一个例子。在这个病例中，我们的患者有长期的OUD，尤其使用芬太尼，在就诊当天开始用丁丙诺啡治疗。她后来因阿片类物质戒断到急诊科就诊，接受了辅助治疗，但症状并未缓解。最后，增加丁丙诺啡的剂量后，患者的症状得到缓解，这突出了又一个病例，进一步证明了越来越多的证据表明，由丁丙诺啡引发的阿片类物质戒断反应可以且应该用增加剂量的丁丙诺啡来治疗。
