Observation and patient disposition after buprenorphine poisoning

Admit all patients with buprenorphine poisoning who require a naloxone infusion, to a critical care unit where airway and breathing can be managed quickly if required. If a patient needs high doses of naloxone to reverse buprenorphine effects, they may need prolonged observation.

Admit any patient who has injected a coformulation of buprenorphine and naloxone for observation, as naloxone has a shorter duration of effect than buprenorphine.

For patients who have not been treated with naloxone, observe them for at least 6 hours if they are asymptomatic, and at least 24 hours if they have any symptoms.

For patients who have been treated with naloxone, only discharge them if they have no evidence of respiratory depression, they have a normal level of consciousness, and it is at least:

  • 2 hours after a single bolus dose of intravenous or intranasal naloxoneDowling 2008
  • 4 hours after a single bolus dose of intramuscular naloxoneDowling 2008
  • 4 hours after a naloxone infusion has been ceased.

Only discharge patients following buprenorphine poisoning in daylight hours. Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after discharge.

Many acute opioid poisonings are deliberate. Assess patients for deliberate self-harm and, if appropriate, refer them for psychiatric evaluation. Also consider referral for management of opioid dependence (see Overview of management of disorders of opioid use). To reduce risk of death from poisonings, discuss the use of take-home naloxone with all patients with hazardous, harmful or dependent use of opioids (and those close to them because they are likely to be the people administering the drug). Take-home naloxone is available as a nasal spray or preprepared injection. It can be obtained free of charge and over-the-counter through the Take Home Naloxone program in all Australian states and territories.