Abstract：
The US Food and Drug Administration approved the once-monthly injectable extended-release buprenorphine product to treat moderate-to-severe opioid use disorders. The patient in our case report had a liposuction procedure and immediately started having opioid withdrawal symptoms after the procedure.
The patient is a 27-year-old African-American woman who injects drugs and has morbid obesity. She enrolled in a medications for addiction treatment program and opted to get treated with extended-release buprenorphine monthly injections. She tolerated them well for a span of 6 months. In one clinic visit, she reported opioid withdrawal symptoms and started purchasing and using sublingual buprenorphine from her acquaintances. On review of history, she underwent liposuction surgery and this triggered the opioid withdrawal symptoms. Examining her abdomen revealed surgical scars at the site of the buprenorphine injection and the residual buprenorphine depot was not palpable.A subcutaneous injection of 300-mg extended release buprenorphine was administered in the right periumbilical area in this clinic visit. The following week, she was doing well and denied any withdrawal symptoms.
This is a unique case of \"iatrogenic opioid withdrawal\" after a fairly common surgical procedure. The extended-release buprenorphine formulation solidifies when it comes into contact with bodily fluids forming a depot. The depot and surrounding adipose tissue may have been removed during the patient\'s liposuction procedure, causing an immediate drop in buprenorphine levels leading to acute opioid withdrawal.This case report highlights the precautions that need to be taken before patients go for a surgical procedure like liposuction.
The patient is a 27-year-old African-American woman who injects drugs and has morbid obesity. She enrolled in a medications for addiction treatment program and opted to get treated with extended-release buprenorphine monthly injections. She tolerated them well for a span of 6 months. In one clinic visit, she reported opioid withdrawal symptoms and started purchasing and using sublingual buprenorphine from her acquaintances. On review of history, she underwent liposuction surgery and this triggered the opioid withdrawal symptoms. Examining her abdomen revealed surgical scars at the site of the buprenorphine injection and the residual buprenorphine depot was not palpable.A subcutaneous injection of 300-mg extended release buprenorphine was administered in the right periumbilical area in this clinic visit. The following week, she was doing well and denied any withdrawal symptoms.
This is a unique case of \"iatrogenic opioid withdrawal\" after a fairly common surgical procedure. The extended-release buprenorphine formulation solidifies when it comes into contact with bodily fluids forming a depot. The depot and surrounding adipose tissue may have been removed during the patient\'s liposuction procedure, causing an immediate drop in buprenorphine levels leading to acute opioid withdrawal.This case report highlights the precautions that need to be taken before patients go for a surgical procedure like liposuction.
摘要：
背景：美国食品和药物管理局批准每月一次注射缓释丁丙诺啡产品用于治疗中度至重度阿片类药物使用障碍。我们的病例报告中的患者进行了抽脂手术，手术后立即开始出现阿片类药物戒断症状。
方法：患者是一名27岁的非洲裔美国女性，她注射药物并患有病态肥胖。她参加了成瘾治疗计划的药物治疗，并选择每月注射丁丙诺啡。她很好地忍受了6个月的时间。在一次诊所访问中，她报告了阿片类药物戒断症状，并开始从熟人那里购买和使用舌下丁丙诺啡。回顾历史，她接受了抽脂手术，这引发了阿片类药物戒断症状。检查她的腹部发现丁丙诺啡注射部位有手术疤痕，残留的丁丙诺啡储库无法触及。在这次临床访问中，在右脐周区皮下注射了300毫克缓释丁丙诺啡。接下来的一周,她情况良好，否认有戒断症状。
结论：这是一个独特的“医源性阿片类药物戒断”病例，经过相当常见的外科手术。缓释丁丙诺啡制剂在与体液接触时固化,形成储库。储库和周围的脂肪组织可能在患者的吸脂过程中被移除，导致丁丙诺啡水平立即下降，导致急性阿片类药物戒断。此病例报告强调了在患者进行抽脂术等外科手术之前需要采取的预防措施。
方法：患者是一名27岁的非洲裔美国女性，她注射药物并患有病态肥胖。她参加了成瘾治疗计划的药物治疗，并选择每月注射丁丙诺啡。她很好地忍受了6个月的时间。在一次诊所访问中，她报告了阿片类药物戒断症状，并开始从熟人那里购买和使用舌下丁丙诺啡。回顾历史，她接受了抽脂手术，这引发了阿片类药物戒断症状。检查她的腹部发现丁丙诺啡注射部位有手术疤痕，残留的丁丙诺啡储库无法触及。在这次临床访问中，在右脐周区皮下注射了300毫克缓释丁丙诺啡。接下来的一周,她情况良好，否认有戒断症状。
结论：这是一个独特的“医源性阿片类药物戒断”病例，经过相当常见的外科手术。缓释丁丙诺啡制剂在与体液接触时固化,形成储库。储库和周围的脂肪组织可能在患者的吸脂过程中被移除，导致丁丙诺啡水平立即下降，导致急性阿片类药物戒断。此病例报告强调了在患者进行抽脂术等外科手术之前需要采取的预防措施。
