FWIW - I personally witnessed a very complicated OD involving bupe as the compound that pushed the OD to lethal levels ha thee been no medical intervention.
Unfortunately naloxone, as we know, does jack shit for bupe involved ODs. This person had ingested some amount of alprazolam, probably abovut ten standard drinks, maybe more and later that night, as the other drugs would have been past but lkely still near peak concentration he took two lines of bupe (subtext generic) - about 1 - 1.5-mg total.
Within 15 minutes he had passed out withut warning, had labored respiratoration and within six hours we called 911 as we could not wake him.
I told the EMTs it was an opioid involved OD with complicating factors and that naloxone would not likely work. They gave him four vials and admitted it wasn't going to do shit, they intubatued him and transported him to an ICU. Ugly shit to watch.
He was put on IV fluids and mechanical ventilation until he could breate for himself again.
Not the worst night of my life but definitely one of his worst.
He was buprenorphine intolerant, likely never had it before. No opioid tolerance beyond maybe 20-mg oxy.
At least with people who have no opioid experince and takes bupe with benzos or alcohol death seems quite possible.
