Material Needs Security and Food Security Among Lebanese Adults with Type 2 Diabetes: A Cross-Sectional Study.

On initial evaluation in the emergency department, vital signs were unremarkable and her examination was notable for somnolence and mild disorientation. Blood testing and neuroimaging were unremarkable. Urine drug testing was positive for amphetamines and negative for barbiturates, cocaine metabolites, opiates, methadone, fentanyl, oxycodone, phencyclidine, and tetrahydrocannabinol metabolites. A serum free buprenorphine concentration, obtained 18 h after arrival, was 2.4 ng/mL. The patient was admitted and the next morning developed bradypnea, miosis, and worsened encephalopathy. Due to concern for buprenorphine-induced encephalopathy, naloxone and nalmefene were trialed with temporary improvement. The next day, the patient’s mental status normalized and she was discharged. At four months follow up, she had no residual effects noted. This case highlights that buprenorphine toxicity should be considered in circumstances of encephalopathy of unclear etiology following long-acting buprenorphine injection, especially once other major potential causes have been ruled out.