Buprenorphine Prescribing Practices and Exposures Reported to a Poison Center — Utah, 2002–2011

• Published in: MMWR. Morbidity and mortality weekly report 2012-12, Vol.61 (49), p.997-1001
• Main Authors: Thomas, Karen C, Malheiro, Marty, Crouch, Barbara I, Porucznik, Christina A
• Format: Article
• Language: English
• Subjects: Addiction; Adolescent; Adult; Adults; Aged; Aged, 80 and over; Ambulatory Care; Buprenorphine; Buprenorphine - administration & dosage; Buprenorphine - adverse effects; Buprenorphine - poisoning; Care and treatment; Chemical hazards; Child; Child, Preschool; Childhood mental disorders; Drug addiction; Female; Human exposure; Humans; Infant; Male; Medical treatment; Medications; Middle Aged; Morbidity; Mortality; Narcotic Antagonists - administration & dosage; Narcotic Antagonists - adverse effects; Narcotic Antagonists - poisoning; Opioid analgesics; Opioid-Related Disorders - drug therapy; Poison Control Centers - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Prescription Drug Misuse; Prescription drugs; Public health; Substance abuse; Utah - epidemiology; Young Adult
• ISSN: 0149-2195; 1545-861X

Buprenorphine is an effective medication for the treatment of opioid dependence. Its use 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. In France, widespread use of medication-assisted therapy, primarily buprenorphine treatment, was associated with an 80% decrease in overdose deaths from heroin or cocaine from 465 in 1996 to 89 in 2003. With the expanded use of buprenorphine, an increase in exposures among children and adults has been reported in the United States. These exposures (including unintentional and intentional, therapeutic and nontherapeutic) have resulted in adverse effects and, in a small number of cases, death. To assess statewide increases in buprenorphine use and the number of reported exposures, the Utah Department of Health analyzed data from the Utah Controlled Substance Database (CSD) and the Utah Poison Control Center (PCC). The results of that analysis 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. Over the same period, the number of exposures to buprenorphine reported annually to the PCC increased from six to 81. However, comparison of the ratios of buprenorphine exposures to patients and prescribers in 2002 with data for 2011 indicated substantial decreases from 6/22 for patients and 6/16 for prescribers in 2002 to 81/9,793 for patients and 81/1,088 for prescribers in 2011. Three of the total 462 buprenorphine exposures reported during 2002-2011 in Utah, in a teen and two adults, were associated with fatal outcomes. Increased buprenorphine prescribing in Utah during 2002-2011 likely represents expanded access to critically needed opioid addiction treatment; however, safeguards should be in place to prevent adverse effects. Prescribers and pharmacists are encouraged to counsel patients carefully regarding the safe use, storage, and disposal of buprenorphine.