title: Double successful buprenorphine/naloxone induction to facilitate cardiac transplantation in an iatrogenically opiate-dependent patient.
abstract: Buprenorphine/naloxone is used for the treatment of opioid dependence. In the following case, a potential use for the medication combination is explored in the arena of transplant surgery. Psychiatry was consulted for a 29-year-old woman with iatrogenic opioid dependence after bilateral ventricular assist device placement for congenital cardiomyopathy. Her ejection fraction was less than 15% and she was considered a poor candidate for transplant due to drug-seeking behaviors. We transitioned her onto buprenorphine/naloxone to prevent abuse and control symptoms, qualifying her for cardiac transplant. After transplant, we coordinated care with cardiothoracic surgeons to restart buprenorphine/naloxone, and the patient has been stable for 8 months.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA. cjcr@hotmail.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Rodgman
authors.forename: Gayle
authors.initials: G
authors.lastname: Pletsch
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D009202:Cardiomyopathies / Q000151:congenital / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007049:Iatrogenic Disease; D009270:Naloxone / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000209:etiology / Q000534:rehabilitation*; D010149:Postoperative Pain / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis
chemical_list: D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine