{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:01:59Z","timestamp":1784106119393,"version":"3.55.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Harm Reduct J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sublingual buprenorphine, approved for treatment of opioid use disorder since 2002, is most commonly available in co-formulation with naloxone. Naloxone is an opioid antagonist minimally absorbed when sublingual (SL) buprenorphine\/naloxone is taken as prescribed; it is thought to reduce potential for misuse via intravenous administration. However, growing data and clinical experience demonstrate that previously accepted assumptions about the pharmacokinetics of these medications may not apply to all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present a patient whose adverse post-administration side effects on SL buprenorphine\/naloxone resolved with transition to SL buprenorphine monoproduct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Naloxone can be detected in nearly all patients taking SL buprenorphine\/naloxone, though with apparent variability in clinical effect. In a minority of patients, naloxone can contribute to adverse and potentially treatment-limiting side effects. Furthermore, the naloxone component is commonly misunderstood by patients and providers and can foster mistrust in the therapeutic relationship if providers are perceived to be withholding a more tolerable formulation. Prescribers should have a low threshold to offer buprenorphine alone when clinically appropriate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12954-024-01054-2","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T05:05:31Z","timestamp":1722315931000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Buprenorphine\/naloxone \u2013 one formulation that doesn\u2019t fit all: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Hannan M.","family":"Braun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Axelrath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"issue":"9","key":"1054_CR1","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1001\/jamapsychiatry.2021.0976","volume":"78","author":"T Santo Jr","year":"2021","unstructured":"Santo T Jr, Clark B, Hickman M, et al. Association of Opioid Agonist Treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and Meta-analysis. JAMA Psychiatry. 2021;78(9):979\u201393. https:\/\/doi.org\/10.1001\/jamapsychiatry.2021.0976.","journal-title":"JAMA Psychiatry"},{"key":"1054_CR2","doi-asserted-by":"publisher","first-page":"e5945","DOI":"10.1136\/bmj.e5945","volume":"345","author":"GJ MacArthur","year":"2012","unstructured":"MacArthur GJ, Minozzi S, Martin N, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945. https:\/\/doi.org\/10.1136\/bmj.e5945.","journal-title":"BMJ"},{"issue":"4","key":"1054_CR3","first-page":"426","volume":"102","author":"C Baum","year":"1987","unstructured":"Baum C, Hsu JP, Nelson RC. The impact of the addition of naloxone on the use and abuse of pentazocine. Public Health Rep. 1987;102(4):426\u20139.","journal-title":"Public Health Rep"},{"issue":"5","key":"1054_CR4","doi-asserted-by":"publisher","first-page":"329","DOI":"10.2165\/00003088-200443050-00005","volume":"43","author":"DS Harris","year":"2004","unstructured":"Harris DS, Mendelson JE, Lin ET, Upton RA, Jones RT. Pharmacokinetics and subjective effects of sublingual buprenorphine, alone or in combination with naloxone: lack of dose proportionality. Clin Pharmacokinet. 2004;43(5):329\u201341.","journal-title":"Clin Pharmacokinet"},{"key":"1054_CR5","doi-asserted-by":"publisher","unstructured":"Mendelson J, Jones RT. Clinical and pharmacological evaluation of buprenorphine and naloxone combinations: why the 4:1 ratio for treatment? Drug and Alcohol Dependence. 2003;70(2, Supplement):S29-S37. https:\/\/doi.org\/10.1016\/S0376-8716(03)00057-7.","DOI":"10.1016\/S0376-8716(03)00057-7"},{"key":"1054_CR6","unstructured":"PCSS. 8 Hour MOUD Training: Medications for Opioid Use Disorder. Presented at: Accessed December 9. 2023. https:\/\/education.sudtraining.org\/Listing\/8-Hour-Online-MAT-Waiver-Training-4607."},{"issue":"7","key":"1054_CR7","doi-asserted-by":"publisher","first-page":"e221821","DOI":"10.1001\/jamahealthforum.2022.1821","volume":"3","author":"TD Nguyen","year":"2022","unstructured":"Nguyen TD, Chua KP, Andraka-Christou B, Bradford WD, Simon K. Trends in Buprenorphine Coverage and prior authorization requirements in US Commercial formularies, 2017\u20132021. JAMA Health Forum. 2022;3(7):e221821. https:\/\/doi.org\/10.1001\/jamahealthforum.2022.1821.","journal-title":"JAMA Health Forum"},{"issue":"3","key":"1054_CR8","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/dta.1464","volume":"6","author":"P Heikman","year":"2014","unstructured":"Heikman P, H\u00e4kkinen M, Gergov M, Ojanper\u00e4 I. Urine naloxone concentration at different phases of buprenorphine maintenance treatment. Drug Test Anal. 2014;6(3):220\u20135. https:\/\/doi.org\/10.1002\/dta.1464.","journal-title":"Drug Test Anal"},{"issue":"6","key":"1054_CR9","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1097\/ADM.0000000000000676","volume":"14","author":"JS Warrington","year":"2020","unstructured":"Warrington JS, Warrington GS, Francis-Fath S, Brooklyn J. Urinary buprenorphine, Norbuprenorphine and naloxone concentrations and ratios: review and potential clinical implications. J Addict Med. 2020;14(6):e344. https:\/\/doi.org\/10.1097\/ADM.0000000000000676.","journal-title":"J Addict Med"},{"issue":"1","key":"1054_CR10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/ADM.0000000000001030","volume":"17","author":"J Gregg","year":"2023","unstructured":"Gregg J, Hartley J, Lawrence D, Risser A, Blazes C. The Naloxone Component of Buprenorphine\/Naloxone: discouraging misuse, but at what cost? J Addict Med. 2023;17(1):7\u20139. https:\/\/doi.org\/10.1097\/ADM.0000000000001030.","journal-title":"J Addict Med"},{"key":"1054_CR11","doi-asserted-by":"publisher","first-page":"549272","DOI":"10.3389\/fpsyt.2020.549272","volume":"11","author":"CK Blazes","year":"2020","unstructured":"Blazes CK, Morrow JD. Reconsidering the usefulness of adding Naloxone to Buprenorphine. Front Psychiatry. 2020;11:549272. https:\/\/doi.org\/10.3389\/fpsyt.2020.549272.","journal-title":"Front Psychiatry"},{"issue":"1","key":"1054_CR12","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/ADM.0000000000000837","volume":"16","author":"LA Grande","year":"2022","unstructured":"Grande LA. Prescribing the Buprenorphine Monoproduct for adverse effects of Buprenorphine-Naloxone. J Addict Med. 2022;16(1):4\u20136. https:\/\/doi.org\/10.1097\/ADM.0000000000000837.","journal-title":"J Addict Med"},{"issue":"2","key":"1054_CR13","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1080\/00952990802585406","volume":"35","author":"RD Bruce","year":"2009","unstructured":"Bruce RD, Govindasamy S, Sylla L, Kamarulzaman A, Altice FL. Lack of reduction in Buprenorphine Injection after introduction of Co-formulated Buprenorphine\/Naloxone to the Malaysian market. Am J Drug Alcohol Abus. 2009;35(2):68\u201372. https:\/\/doi.org\/10.1080\/00952990802585406.","journal-title":"Am J Drug Alcohol Abus"},{"issue":"5","key":"1054_CR14","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1097\/ADM.0000000000000045","volume":"8","author":"MR Lofwall","year":"2014","unstructured":"Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315\u201326. https:\/\/doi.org\/10.1097\/ADM.0000000000000045.","journal-title":"J Addict Med"},{"key":"1054_CR15","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.drugalcdep.2017.06.033","volume":"179","author":"JD Jones","year":"2017","unstructured":"Jones JD, Manubay JM, Mogali S, et al. Abuse liability of intravenous buprenorphine vs. buprenorphine\/naloxone: importance of absolute naloxone amount. Drug Alcohol Depend. 2017;179:362\u20139. https:\/\/doi.org\/10.1016\/j.drugalcdep.2017.06.033.","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"1054_CR16","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1111\/j.1360-0443.2009.02843.x","volume":"105","author":"SD Comer","year":"2010","unstructured":"Comer SD, Sullivan MA, Vosburg SK, et al. Abuse liability of intravenous buprenorphine\/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusers. Addiction. 2010;105(4):709\u201318. https:\/\/doi.org\/10.1111\/j.1360-0443.2009.02843.x.","journal-title":"Addiction"},{"issue":"3","key":"1054_CR17","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/0376-8716(92)90061-g","volume":"30","author":"LL Weinhold","year":"1992","unstructured":"Weinhold LL, Preston KL, Farre M, Liebson IA, Bigelow GE. Buprenorphine alone and in combination with naloxone in non-dependent humans. Drug Alcohol Depend. 1992;30(3):263\u201374. https:\/\/doi.org\/10.1016\/0376-8716(92)90061-g.","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"1054_CR18","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1124\/jpet.102.038141","volume":"303","author":"SD Comer","year":"2002","unstructured":"Comer SD, Collins ED. Self-administration of intravenous buprenorphine and the buprenorphine\/naloxone combination by recently detoxified heroin abusers. J Pharmacol Exp Ther. 2002;303(2):695\u2013703. https:\/\/doi.org\/10.1124\/jpet.102.038141.","journal-title":"J Pharmacol Exp Ther"},{"issue":"3","key":"1054_CR19","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00213-010-1898-4","volume":"211","author":"AN Duke","year":"2010","unstructured":"Duke AN, Correia CJ, Walsh SL, Bigelow GE, Strain EC. Acute effects of intramuscular and sublingual buprenorphine and buprenorphine\/naloxone in non-dependent opioid abusers. Psychopharmacology. 2010;211(3):303\u201312. https:\/\/doi.org\/10.1007\/s00213-010-1898-4.","journal-title":"Psychopharmacology"},{"issue":"1","key":"1054_CR20","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.drugalcdep.2006.09.012","volume":"88","author":"H Alho","year":"2007","unstructured":"Alho H, Sinclair D, Vuori E, Holopainen A. Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users. Drug Alcohol Depend. 2007;88(1):75\u20138. https:\/\/doi.org\/10.1016\/j.drugalcdep.2006.09.012.","journal-title":"Drug Alcohol Depend"},{"key":"1054_CR21","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.forsciint.2018.08.010","volume":"291","author":"P Kriikku","year":"2018","unstructured":"Kriikku P, H\u00e4kkinen M, Ojanper\u00e4 I. High buprenorphine-related mortality is persistent in Finland. Forensic Sci Int. 2018;291:76\u201382. https:\/\/doi.org\/10.1016\/j.forsciint.2018.08.010.","journal-title":"Forensic Sci Int"},{"key":"1054_CR22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.drugalcdep.2018.09.007","volume":"193","author":"TJ Cicero","year":"2018","unstructured":"Cicero TJ, Ellis MS, Chilcoat HD. Understanding the use of diverted buprenorphine. Drug Alcohol Depend. 2018;193:117\u201323. https:\/\/doi.org\/10.1016\/j.drugalcdep.2018.09.007.","journal-title":"Drug Alcohol Depend"},{"key":"1054_CR23","doi-asserted-by":"publisher","first-page":"102722","DOI":"10.1016\/j.drugpo.2020.102722","volume":"79","author":"RG Carlson","year":"2020","unstructured":"Carlson RG, Daniulaityte R, Silverstein SM, Nahhas RW, Martins SS. Unintentional drug overdose: is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose? Int J Drug Policy. 2020;79:102722. https:\/\/doi.org\/10.1016\/j.drugpo.2020.102722.","journal-title":"Int J Drug Policy"},{"issue":"12","key":"1054_CR24","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1111\/acem.14814","volume":"30","author":"JR Morgan","year":"2023","unstructured":"Morgan JR, Assoumou SA. The limits of innovation: directly addressing known challenges is necessary to improve the real-world experience of novel medications for opioid use disorder. Acad Emerg Med. 2023;30(12):1285\u20137. https:\/\/doi.org\/10.1111\/acem.14814.","journal-title":"Acad Emerg Med"},{"issue":"19","key":"1054_CR25","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1056\/NEJMp2101298","volume":"384","author":"E Poorman","year":"2021","unstructured":"Poorman E. The number needed to Prescribe \u2014 what would it take to Expand Access to Buprenorphine? N Engl J Med. 2021;384(19):1783\u20134. https:\/\/doi.org\/10.1056\/NEJMp2101298.","journal-title":"N Engl J Med"}],"container-title":["Harm Reduction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01054-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12954-024-01054-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01054-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T05:09:14Z","timestamp":1722316154000},"score":1,"resource":{"primary":{"URL":"https:\/\/harmreductionjournal.biomedcentral.com\/articles\/10.1186\/s12954-024-01054-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,30]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1054"],"URL":"https:\/\/doi.org\/10.1186\/s12954-024-01054-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4339498\/v1","asserted-by":"object"}]},"ISSN":["1477-7517"],"issn-type":[{"value":"1477-7517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,30]]},"assertion":[{"value":"29 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"While the patient details discussed in this case report are de-identified, the patient has signed a permission to publish form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"143"}}