Adverse effects in children after unintentional buprenorphine exposure

Buprenorphine in sublingual formulation was recently introduced to the American market for treatment of opioid dependence. We report a series of 5 toddlers with respiratory and mental-status depression after unintentional buprenorphine exposure. Despite buprenorphine's partial agonist activity and ceiling effect on respiratory depression, all children required hospital admission and either opioid-antagonist therapy or mechanical ventilation. Results of routine urine toxicology screening for opioids were negative in all cases. Confirmatory testing was sent for 1 child and returned with a positive result. The increasing use of buprenorphine as a home-based therapy for opioid addiction in the United States raises public health concerns for the pediatric population. Key Words: buprenorphine, unintentional ingestion, respiratory depression, opioid, pediatric, exploratory behavior Abbreviations: ED, emergency department; CNS, central nervous system
BUPRENORPHINE, ALONE OR in combination with naloxone, has been approved in the United States for the treatment of opioid addiction. Unlike traditional methadone-maintenance therapy, buprenorphine is prescribed for outpatient administration [...]