{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T03:17:51Z","timestamp":1774322271411,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.120821.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000}}],"reference-count":23,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008944","name":"Iowa Department of Public Health","doi-asserted-by":"publisher","award":["5881SA144E"],"award-info":[{"award-number":["5881SA144E"]}],"id":[{"id":"10.13039\/100008944","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008944","name":"Iowa Department of Public Health","doi-asserted-by":"publisher","award":["5881SA145E"],"award-info":[{"award-number":["5881SA145E"]}],"id":[{"id":"10.13039\/100008944","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008944","name":"Iowa Department of Public Health","doi-asserted-by":"publisher","award":["5881SA137E"],"award-info":[{"award-number":["5881SA137E"]}],"id":[{"id":"10.13039\/100008944","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["T25HP37624"],"award-info":[{"award-number":["T25HP37624"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["TI081620"],"award-info":[{"award-number":["TI081620"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Buprenorphine, a partial agonist of the mu-opioid receptor, is an increasingly prescribed medication for maintenance treatment of opioid use disorder. When this medication is taken in the context of active opioid use, precipitated withdrawal can occur, leading to acute onset of opioid withdrawal symptoms. Fentanyl complicates use of buprenorphine, as it slowly releases from body stores and can lead to higher risk of precipitated withdrawal.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Objectives:<\/ns4:bold>\n                    Describe the successful management of buprenorphine precipitated opioid withdrawal from fentanyl with high doses of buprenorphine. We seek to highlight how no adverse effects occurred in this patient and illustrate his stable transition to outpatient treatment.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Case report:<\/ns4:bold>\n                    We present the case of a patient with severe opioid use disorder who presented in moderately severe opioid withdrawal after taking non-prescribed buprenorphine-naloxone which precipitated opioid withdrawal from daily fentanyl use. He was treated with high doses of buprenorphine, 148 mg over the first 48 hours, averaging 63 mg per day over four days. The patient reported rapid improvement in withdrawal symptoms without noted side effects and was able to successfully taper to 16 mg twice daily by discharge.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    This case demonstrates the safety and effectiveness of buprenorphine at high doses for treatment of precipitated withdrawal. While other options include symptomatic withdrawal management, initiating methadone or less researched options like ketamine, utilizing buprenorphine can preserve or re-establish confidence in this life-saving medication. This case also increases the previously documented upper boundary on buprenorphine dosing for withdrawal and should provide additional confidence in its use.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.120821.2","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T06:10:07Z","timestamp":1691647807000},"page":"487","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8847-8727","authenticated-orcid":false,"given":"Nicholas L.","family":"Bormann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antony","family":"Gout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2295-7335","authenticated-orcid":false,"given":"Vicki","family":"Kijewski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0966-6605","authenticated-orcid":false,"given":"Alison","family":"Lynch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"90-96","DOI":"10.1016\/j.jsat.2017.07.001","article-title":"Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population.","volume":"85","author":"J Morgan","year":"2018","journal-title":"J. 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Varshneya, Center for Drug Evaluation and Research, Food and Drug Administration, United States Department of Health and Human Services, Silver Spring, MD, 07 Sep 2023, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/11-487\/v2#referee-response-195439","order":0,"name":"referee-response-195439","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.132683.r189490, Ethan O Bryson, Icahn School of Medicine at Mount Sinai, New York, 03 Aug 2023, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-487\/v1#referee-response-189490","order":1,"name":"referee-response-189490","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Funding: N.L.B. was supported by the University of Iowa Carver College of Medicine Physician Scientist Training Pathway, Iowa City, IA. A.L. was supported by grants from the Iowa Department of Public Health State Opioid Response Corrections Liaison and SBIRT (5881SA144E, 5881SA145E, and 5881SA137E), Des Moines, IA; the Substance Abuse and Mental Health Services Administration (TI081620), Rockville, MD; and the Health Resources and Services Administration (T25HP37624), Washington, DC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}