Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center

Abstract

Context: Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes.

Study design: We performed a retrospective cohort study at a single pediatric tertiary care center of children between the age of 6 months and 7 years of age hospitalized between 1 January 2006 and 1 September 2014 with report of buprenorphine or buprenorphine/naloxone exposure. Patients with possible exposure to more than one agent were excluded. We extracted clinical findings, including time to respiratory depression, interventions, and disposition from the medical record.

Results: Eighty-eight patients met the inclusion criteria. Seven patients were excluded. The median age was 24 months [IQR 18–30]. 20 patients (23%) received activated charcoal while 48 (55%) were treated with naloxone. 36 (41%) patients were admitted to the ICU. Observed clinical effects included respiratory depression (83%), oxygen saturation by pulse oximetry (SpO₂)< 93% (28%), depressed mental status (80%), miosis (77%), and emesis (45%). Median time from exposure to respiratory depression was 263 min [IQR 105–486]. The median hospital length of stay was 22 h [IQR 20–26] and was positively associated with estimated exposure dose (p = 0.002).

Conclusion: Pediatric patients exposed to buprenorphine are likely to exhibit signs and symptoms of opioid toxicity, including respiratory depression, altered mental status and miosis. Although the majority of patients developed signs of clinical toxicity within 8 h of reported exposure, the optimum duration of monitoring remains unclear.

Keywords:

• Poisoning
• overdose
• opioids
• injury prevention

Acknowledgements

Michael Monuteaux, Sc. D. is an Assistant Professor of Pediatrics, Harvard Medical School Scientific Director, Design & Analysis Core, Clinical Research Center Senior Epidemiologist and Biostatistician, Division of Emergency Medicine. He analyzed data but did not meet authorship criteria. No compensation was received. Written permission was obtained from Dr Monuteaux to be acknowledged in this section.

Disclosure statement

None of the authors have any conflicts of interest.