Seattle Did It: Bupe after OD!

According to the Seattle Mayor's office and MyNorthwest, emergency medical technicians with the Seattle Fire Department now offer buprenorphine (Suboxone and others) to opioid drug overdose (OD) victims in the field after first reversing the OD with naloxone. Not only might this approach lead more people suffering from addiction to continue a an addiction treatment that really works, but buprenorphine may work better than naloxone (Narcan and others) alone. You may notice that Suboxone itself contains naloxone, but when administered sublingually, little naloxone may enter the bloodstream.

Buprenorphine, an opioid mu receptor partial agonist, can, by itself, put someone addicted to these drugs in withdrawal. It might even reverse an overdose by itself. Naloxone has a short duration of action, so when using it to reverse overdoses of longer acting drugs like heroin and methadone, the blocking effect of the naloxone may wear off, so that the overdosed drug still kills the patient. We also know that naloxone, like buprenorphine, when administered to anyone addicted to most opioids, will put them in withdrawal. Remember that scene in Trainspotting? Addition of bupe might soften that effect.

Best of all, some overdose victims dosed with bupe after naloxone may like the drug and decide to enter long-term maintenance treatment with it. Also, experience with this approach may help us discover whether we can reverse opioid overdoses with buprenorphine alone.

Way to go, Seattle!

Berry Edwards, MD