Buprenorphine is a somewhat mild opioid that was approved by the Federal Drug Administration (FDA) in 2002 to treat opioid dependence. It belongs to a class of drugs called mixed opioid agonist-antagonists. Th drug helps prevent withdrawal symptoms brought on by decreasing and eventually eliminating exposure to opioids by those addicted.
The leading brand name manufacturers of buprenorphine chose voluntarily to pull their products from the market back in 2013. And, yet, exposure by children under six to this drug in recent years rose over seventeen percent, according to researcher Gary Smith, MD, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, and his colleague in a study published in Pediatrics. There are over 11,000 cases reported involving children nineteen and younger, with 86.1 percent being those under six years of age. Generic versions of buprenorphine were not included in the study, and thus, the authors speculate these numbers could be slightly higher.
“Buprenorphine is an important medication and it’s part of the curriculum for treating opioid abuse disorder, but as we listen to national discussions about the use of medication-assisted treatment, including with buprenorphine, they often leave out the unintended exposures in children under the age of six,” Smith said. “We did this study to see how big the problem is in this group under six and to get a handle on what the opportunities were in decreasing this unintentional exposure.”
Also, an alarming 77.1% of ingestions reported in teens were intentional, with 150 cases related to attempted suicide. Only one case reported that fell into that category actually resulted in death. There were nearly 800 cases where adolescents ingested buprenorphine intentionally that were not considered attempted suicides, but rather for experimentation, and two deaths reported in this category.
Factors contributing to the overall decrease in buprenorphine exposures included the use of unit-dose packaging. However, this has yet to be made a requirement. “There is not currently a requirement to provide all buprenorphine products in some type of unit-dose packaging, which would decrease access,” Smith said. He also suggested that there be more access to mental health intervention for adolescents who may be contemplating suicide.
“This study is ultimately a cautionary tale about where we are in the opioid crisis,” said Carl Baum, MD, a pediatric emergency medicine physician at Yale New Haven Children’s Hospital in Connecticut. “Yes, we do have buprenorphine, which is a powerful drug to help combat the opioid crisis, but because it is still an opioid, children can get into trouble with it.”
George Sam Wang, MD, of the University of Colorado Anschutz Medical Campus, recently conducted research on accidental buprenorphine exposure and reported similar findings. The study he was involved with also suggests the use of unit-dose packaging to limit exposure to children.
“It’s really plain when you have two different groups of researchers coming to the same conclusion regarding this topic,” Smith said. “We wanted to underscore what was going on and that unit-dose packaging should be something that’s used more universally for these products.”