A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

Satoru Takahashi; Tomoko Mita; Eri Murakami; Masashi Endo; Kaichiro Tamba; Satoshi Hasegawa; Katsuyuki Shirai

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A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

VernacularTitle:ブプレノルフィン経皮吸収製剤の予定外中断により急性退薬症状を来した在宅訪問診療患者の1例—社会的考察を含め—
Author: Satoru TAKAHASHI ¹ ; Tomoko MITA ² ; Eri MURAKAMI ³ ; Masashi ENDO ¹ ; Kaichiro TAMBA ⁴ ; Satoshi HASEGAWA ⁵ ; Katsuyuki SHIRAI ¹
Author Information

1. Department of Radiation Oncology, Jichi Medical University Hospital
2. Shonankai Kusunoki Home Medical Clinic
3. Department of Radiology, National Hospital Organization Tochigi Medical Center
4. Division of Palliative Care Medicine, Jichi Medical University Hospital
5. Takano Pharmacy, Freddie corp.
Keywords: buprenorphine; transdermal patch; withdrawal symptoms; non-cancer pain; intractable pain
From:Palliative Care Research 2023;18(1):89-94
CountryJapan
Language:Japanese
Abstract: Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.