January 9, 2013
CDC: Pharmacists Should Counsel on Safe HandlingAtlanta—Counseling from pharmacists regarding the safe use, storage, and disposal of buprenorphine can help prevent adverse consequences from unintentional exposure among children or diversion and experimentation among teens and adults, according to the CDC.
In fact, according to the CDC, “In certain cases, health-care provider counseling might prevent a fatality.”
Public health officials note that as use of buprenorphine has increased rapidly since 2002, U.S. poison control centers are observing increases in unintentional exposures to the drug.
While valuable to help reduce prescription opioid abuse and misuse, buprenorphine can cause serious and potentially life-threatening effects among children and adults when used inappropriately.
“Young children exploring their environments might lick or ingest this medication, resulting in vomiting, respiratory depression, coma, or death,” according to the report in the CDC's Morbidity and Mortality Weekly Report (MMWR).
Use of buprenorphine has increased in the United States as a result of the Drug Addiction Treatment Act of 2000, which allowed physicians to prescribe certain medications as part of office-based treatment for opioid addiction.
The expanded use, however, also has increased the number of exposures—unintentional and intentional, therapeutic and nontherapeutic—resulting in adverse effects, including some deaths.
In Utah, for example, data from the Utah Controlled Substance Database (CSD) and the Utah Poison Control Center (PCC) indicated a statewide increase in the annual number of patients prescribed buprenorphine from 22 in 2002 to 9,793 in 2011, and a concurrent increase in the annual number of prescribers writing buprenorphine prescriptions from 16 to 1,088.
During that time period, the number of exposures to buprenorphine reported annually to the PCC increased from six to 81. In three of the total 462 buprenorphine exposures reported during 2002–2011 in Utah, a teen and two adults died.
Part of the problem is the misconception that buprenorphine is unlikely to produce adverse effects. The report notes that, “Similar to other opioids, buprenorphine produces euphoria and respiratory depression in a dose-dependent manner. However, unique to buprenorphine, these effects increase until, at moderate doses, the effects reach a plateau and no longer continue to increase, making respiratory depression less likely in a habituated opioid user.”
In an opioid-naïve patient, however, “respiratory depression might occur before reaching this ceiling, especially in young children,” the MMWR warns.
In Utah, of the 462 exposures recorded in the PCC database during the 9-year period, the majority, 54.1%, were among adults aged 20 years old or older; 179, 38.7%, were among children 5 years old or younger; and 33, 7.1%, were among young people from 6 to 19 years old. Nearly all, 94%, of the exposures among children less than 5 years old were to sublingual tablets instead of the buprenorphine film product, which was not approved until 2010.
“Counseling by health-care providers about the potential dangers to children from licking a buprenorphine film package or holding a sublingual tablet in the mouth, even briefly, might help caregivers learn the importance of early intervention in any buprenorphine exposure,” according to a commentary accompanying the report.
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