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A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder

Chang, Derek, C., MD; Klimas, Jan, MSc, PhD; Wood, Evan, MD, PhD; Fairbairn, Nadia, MD

doi: 10.1097/ADM.0000000000000359
Case Report
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Background: Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term tapers of opioid agonist/partial agonist medications, such as methadone and buprenorphine/naloxone, are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still commonplace in medically supervised withdrawal settings.

Case summary: We report a case of an individual with opioid use disorder who was prescribed a rapid buprenorphine/naloxone taper in a medically supervised withdrawal facility and who had a subsequent opioid overdose and death after discharge.

Discussion: The fatal outcome in this case study underscores the potential severe harms associated with use of rapid tapers. Given the increased overdose risk, tapers should be avoided and continuing care strategies, such as maintenance pharmacotherapy, should be initiated in medically supervised withdrawal settings.

British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada (DCC, JK, EW, NF); Department of Family Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada (DCC); School of Medicine, University College Dublin, Belfied, Dublin, Ireland (JK); and Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada (EW, NF).

Send correspondence to Nadia Fairbairn, MD, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. E-mail: nfairbairn@cfenet.ubc.ca.

Received 17 April, 2017

Accepted 29 August, 2017

Author contributions: Dr Wood provided the case. Dr Chang conducted the literature review and wrote the first draft of the manuscript. Drs Fairbairn and Klimas supervised, consulted, and supported the subsequent drafts of the manuscript. All authors contributed to, and have approved, the final draft of manuscript for submission.

Funding: The study was supported by the US National Institutes of Health (R25DA037756).

Conflicts of interest: This research was undertaken, in part, thanks to funding from the Canada Research Chairs program, through a Tier 1 Canada Research Chair in Inner City Medicine, which supports Dr Evan Wood. The ELEVATE: Irish Research Council International Career Development Fellowship, co-funded by Marie Cure Actions (ELEVATEPD/2014/6); and the European Commission grant (701698), supported Dr Jan Klimas. Dr Nadia Fairbairn is supported by a Scholar award from the Michael Smith Foundation for Health Research/St. Paul's Foundation, a Canada Addiction Medicine Research Fellowship (US National Institute on Drug Abuse, R25-DA037756), and the Research in Addiction Medicine Scholars Program (US National Institute on Drug Abuse, R25DA033211). The authors declare no conflicts of interest and the funding organization had no role in the design and conduct of the study; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

© 2018 American Society of Addiction Medicine