Oral Health Risks of Transmucosal Buprenorphine: Commentary on Tuan et al. and Zheng et al.
Open accessAbstract
Opioid use disorder affects millions of people nationally and in 2022 opioid overdose deaths exceeded 80,000. Buprenorphine, a partial mu-opioid receptor agonist, is a gold standard treatment for opioid use disorder, improving withdrawal symptoms and decreasing opioid-related mortality. However, a 2022 Food and Drug Administration warning about oral health problems related to transmucosal formulations has precipitated new research into this medication's potential risks. Two timely studies included in this issue of Journal of Addiction Medicine provide important new insight into potential causal effects and mechanisms of transmucosal buprenorphine's impact on oral disease. Using propensity score-weighted survival analysis, Tuan and colleagues demonstrated significantly greater risk for oral health problems in patients with opioid use disorder exposed to transmucosal buprenorphine compared to those not exposed. Taking a vastly different approach, Zheng and colleagues explored mechanisms of oral health risk by exposing rats to transmucosal or intravenous buprenorphine. Results described prolonged oral fluid buprenorphine exposure, a condition proposed to increase risk for tooth decay, was associated with greater accumulated buprenorphine in the salivary gland associated with sublingual buprenorphine administration. These novel studies advance our understanding of the plausibility of a causal relationship between transmucosal buprenorphine and oral health problems and suggest the importance of prescriber-patient discussions about risk mitigating oral hygiene practices and close monitoring of oral disease development. Additional research is needed into the relative oral health risks of full-opioid agonist versus transmucosal buprenorphine exposure and current barriers to long-acting injectable buprenorphine.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 30 cited sources checked · 0 supported · 0 flagged
- Premisecitation
Hydrocodone and oxycodone can cause xerostomia.
“Commonly prescribed full opioid agonists such as hydrocodone and oxycodone are known to cause xerostomia13 and can impair immune function,14 both of which may promote dental caries, tooth decay and tooth loss, and these effects may be dose dependent.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Götrick B, Åkerman S, Ericson D, Oral pilocarpine for treatment of opioid-induced oral dryness in healthy adults. J Dent Res. 2004; 83: 393– 397. 15111631
Not checked in the free run.
- Premisecitation
Among fentanyl-exposed patients, LAIB was superior to TMB for urine samples negative for fentanyl.
“Both buprenorphine treatments were effective in reducing opioid withdrawal and cravings, but LAIB was superior to TMB for urine samples negative for fentanyl among patients who were fentanyl-exposed.12”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Nunes EV, Comer SD, Lofwall MR, Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7: e2417377– e2417377. 38916892 PMC11200143 source
Not checked in the free run.
- Study design and conductcitation
Tuan and colleagues addressed two weaknesses of Etminan and colleagues by including covariates in propensity score weights that accounted for differences in oral health and TMB exposure, including preexisting oral health diagnoses and healthcare utilization.
“Tuan and colleagues address 2 primary weaknesses identified by Etminan and colleagues by including in the calculation of propensity score weights an array of covariates accounting for differences in oral health and TMB exposure, including preexisting oral health diagnoses and healthcare utilization.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Tuan et al.
Not checked in the free run.
- Premisecitation
Tuan and colleagues observed greater risk for oral health problems as early as one month after TMB initiation.
“Greater risk for oral health problems was observed as early as 1 month following TMB initiation.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Tuan et al.
Not checked in the free run.
- Premisecitation
Buprenorphine use is linked to lower opioid-related death rates.
“A partial mu-opioid receptor agonist, buprenorphine effectively treats opioid withdrawal symptoms and is associated with reduced opioid-related mortality.4,5”
- Also stated in: § CONCLUSIONS · boosted
“In light of buprenorphine’s unequivocal benefits for OUD management including reduced mortality in an era where 10,000 of patients are lost to opioid overdose death each year”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [4] Gowing L, Ali R, White JM. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2009; 3: CD002025. 19588330 source
Not checked in the free run.
- cites [5] Larochelle MR, Bernson D, Land T, Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Annals Intl Med. 2018; 169: 137– 145. PMC6387681 29913516 source
Not checked in the free run.
- Also stated in: § CONCLUSIONS · boosted
- Premisecitation
In propensity score-weighted survival models, Tuan and colleagues found greater risk of adverse oral health outcomes among patients exposed to TMB than among unexposed patients.
“Using propensity score–weighted survival analysis, Tuan and colleagues demonstrated significantly greater risk for oral health problems in patients with opioid use disorder exposed to transmucosal buprenorphine compared to those not exposed.”
- Also stated in: § Abstract · plain
“In propensity score–weighted survival models, results supported greater risk for adverse oral health outcomes for TMB-exposed patients compared to unexposed.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Tuan et al.
Not checked in the free run.
- Also stated in: § Abstract · plain
- Premisecitation
Zheng and colleagues found prolonged oral fluid buprenorphine exposure in rats.
“the authors explored the relationship between the salivary gland, oral fluid, and blood exposure in accounting for prolonged oral fluid buprenorphine exposure, a condition proposed to increase risk for biofilm formation of Streptococcus mutans, the primary agent in tooth decay.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Zheng et al.
Not checked in the free run.
- Rests on an assumption: Streptococcus mutans is the primary agent in tooth decay.
- Interpretationreasoning
Clear evidence that TMB causes oral health problems has remained unavailable without more rigorous study designs such as randomized controlled trials.
“Clear evidence for a causal effect of TMB has remained elusive to date in the absence of more rigorous study designs including randomized controlled trials.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Etminan M, Rezaeianzadeh R, Kezouh A, Association between sublingual buprenorphine-naloxone exposure and dental disease. JAMA. 2022; 328: 2269– 2271. 36511932 PMC9856241 source
Not checked in the free run.
- cites [9] Etminan M, Rezaeianzadeh R. Sublingual buprenorphine-naloxone exposure and dental disease—Reply. JAMA. 2023; 329: 1224– 1225. 37039794 source
Not checked in the free run.
- Premisecitation
Buprenorphine is a standard first-line treatment for opioid use disorder.
“Buprenorphine, a partial mu-opioid receptor agonist, is a gold standard treatment for opioid use disorder, improving withdrawal symptoms and decreasing opioid-related mortality.”
- Also stated in: § Abstract · boosted
“Buprenorphine is a gold standard treatment for OUD with evidence supporting its superior safety and effectiveness compared to other OUD treatment options.3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Mariolis T, Bosse J, Martin S, A systematic review of the effectiveness of buprenorphine for opioid use disorder compared to other treatments: Implications for research and practice. J Addict Res Ther. 2019; 10: 379.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § Abstract · boosted
- Premisecitation
Zheng and colleagues found greater accumulation of buprenorphine in the salivary gland associated with sublingual buprenorphine administration.
“The authors identified the relevance of accumulated buprenorphine in the salivary gland, associated with sublingual buprenorphine administration.”
- Also stated in: § Abstract · plain
“Results described prolonged oral fluid buprenorphine exposure, a condition proposed to increase risk for tooth decay, was associated with greater accumulated buprenorphine in the salivary gland associated with sublingual buprenorphine administration.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Zheng et al.
Not checked in the free run.
- Also stated in: § Abstract · plain
- Premisecitation
Etminan and colleagues' 2022 retrospective cohort study of more than 21,000 new users of sublingual buprenorphine/naloxone found greater oral health risks, including dental caries and tooth loss, compared with transdermal buprenorphine or oral naltrexone.
“A 2022 a retrospective cohort study by Etminan and colleagues8 of over 21,000 new users of sublingual buprenorphine/naloxone demonstrated greater TMB-associated oral health risks, including dental caries and tooth loss, relative to transdermal buprenorphine or oral naltrexone.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Etminan M, Rezaeianzadeh R, Kezouh A, Association between sublingual buprenorphine-naloxone exposure and dental disease. JAMA. 2022; 328: 2269– 2271. 36511932 PMC9856241 source
Not checked in the free run.
- Interpretationcitation
The Tuan and Zheng studies increase the plausibility that TMB has a causal relationship with oral health problems.
“These novel studies advance our understanding of the plausibility of a causal relationship between transmucosal buprenorphine and oral health problems and suggest”
- Also stated in: § Abstract · boosted
“Applying advanced quasi-experimental and mechanism-exploring methods, these 2 studies distinctly advance the plausibility of a causal relationship between TMB and oral health problems that underscores the urgency of testing risk-mitigating measures.”
Quote in the paperSubstantial claim- Rests on an assumption: Findings from rats given buprenorphine can be generalized to humans for assessing oral health risk.
- Rests on an assumption: Streptococcus mutans is the primary agent in tooth decay.
- Also stated in: § Abstract · boosted
- Premisecitation
Hydrocodone and oxycodone can impair immune function.
“Commonly prescribed full opioid agonists such as hydrocodone and oxycodone are known to cause xerostomia13 and can impair immune function,14 both of which may promote dental caries, tooth decay and tooth loss, and these effects may be dose dependent.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Ninković J, Roy S. Role of the mu-opioid receptor in opioid modulation of immune function. Amino Acids. 2013; 45: 9– 24. 22170499 PMC3912755
Not checked in the free run.
- Premisecitation
In January 2022 the FDA warned that transmucosal buprenorphine is associated with dental problems including tooth decay, cavities, infections, and tooth loss, with onset from two weeks to several years after exposure.
“In January 2022, the US Food and Drug Administration (FDA) released a warning about dental problems associated with transmucosal buprenorphine (TMB),6 including tooth decay, cavities, infections, and tooth loss manifesting 2 weeks to several years after buprenorphine exposure.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Knopf A. FDA warns about dental problems with buprenorphine medicines dissolved in the mouth. Brown Univ Child Adolescent Psychopharmacol Update. 2022; 24: 8.
Not checked in the free run.
- Premisecitation
Tuan and colleagues found an accumulated dose-associated increase in risk in a sensitivity analysis limited to patients with longer-term TMB exposure.
“An accumulated dose-associated increase in risk was demonstrated in a sensitivity analysis restricted to patients with longer-term TMB exposure.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Tuan et al.
Not checked in the free run.
- Premisecitation
Buprenorphine reduces opioid withdrawal symptoms.
“A partial mu-opioid receptor agonist, buprenorphine effectively treats opioid withdrawal symptoms and is associated with reduced opioid-related mortality.4,5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] Gowing L, Ali R, White JM. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2009; 3: CD002025. 19588330
Not checked in the free run.
- Premisecitation
Post hoc comparisons from a randomized controlled trial comparing LAIB with TMB showed notable but underpowered group differences favoring LAIB for urine samples negative for any opioid.
“Post hoc comparisons from a randomized controlled trial comparing LAIB to TMB showed notable, but underpowered, group differences favoring the former for urine samples negative for any opioid.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Nunes EV, Comer SD, Lofwall MR, Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7: e2417377– e2417377. 38916892 PMC11200143 source
Not checked in the free run.
- Premisecitation
High-dose TMB may be needed to block ultra-high potency and high affinity opioids by reducing mu-opioid receptor availability.
“High-dose TMB may be needed to block the effects of ultra-high potency and high affinity opioids by reducing mu-opioid receptor availability.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] Greenwald MK, Comer SD, Fiellin DA. Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: Implications for clinical use and policy. Drug Alcohol Depend. 2014; 144: 1– 11. 25179217 PMC4252738 source
Not checked in the free run.
- May combine two claims. 8
- Classified as probably not a substantial claim. 7
May combine two claims.
PremisecitationBoth LAIB and TMB were effective in reducing opioid withdrawal and cravings.
“Both buprenorphine treatments were effective in reducing opioid withdrawal and cravings, but LAIB was superior to TMB for urine samples negative for fentanyl among patients who were fentanyl-exposed.12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Nunes EV, Comer SD, Lofwall MR, Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7: e2417377– e2417377. 38916892 PMC11200143 source
Not checked in the free run.
May combine two claims.
InterpretationcitationCritical evidence is accumulating in support of the 2022 FDA warning about TMB oral health risks, suggesting greater risk of adverse outcomes for patients exposed to TMB compared with no exposure or with other buprenorphine formulations for opioid use disorder.
“Critical evidence is accumulating in support of a 2022 FDA warning about the oral health risks of TMB, suggesting greater risk for adverse outcomes for patients exposed to TMB compared to no exposure, or exposure to other buprenorphine formulations for OUD.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEtminan and colleagues' sampling strategy and conclusions drew criticism and concern that misinterpreted results could affect practice.
“The study’s sampling strategy and conclusions drew criticism and concern about the potential impact of misinterpreted results on practice.9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Etminan M, Rezaeianzadeh R. Sublingual buprenorphine-naloxone exposure and dental disease—Reply. JAMA. 2023; 329: 1224– 1225. 37039794 source
Not checked in the free run.
Classified as probably not a substantial claim.
Premisenone givenThe relative oral health risks of TMB compared with long-term full opioid agonist therapy are not well known.
“The relative oral health risks of TMB versus LTOT are not well known, highlighting another critical gap warranting examination.”
- Also stated in: § CONCLUSIONS · plain
“The relative risks of full agonist versus partial agonist opioids remain unexplored, and evidence regarding this comparison could address a high-risk barrier to patients’ switching from LTOT when indicated.”
Quote in the paperSubstantial claim- Also stated in: § CONCLUSIONS · plain
Probably not a substantial claim: may not pass S4 (based). May combine two claims.
InterpretationreasoningWarnings about TMB oral health risks could discourage patients from switching away from long-term full opioid agonist therapy, leaving them at unknown risk for the same negative oral health outcomes.
“Warnings about the oral health risks of TMB could deter patients from switching away from LTOT, leaving them at unknown risk for the same negative oral health outcomes.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationcitationDirect comparisons showing comparable outcomes for long-acting injectable buprenorphine relative to TMB suggest that LAIB may be a viable alternative for patients at high risk of oral health problems, including fentanyl-exposed patients who may need higher sublingual doses.
“Direct comparisons showing comparable outcomes for long-acting injectable buprenorphine (LAIB) relative to TMB suggest LAIB may be a viable treatment alternative for patients at high risk for oral health problems, including patients exposed to fentanyl who may require higher sublingual doses.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Nunes EV, Comer SD, Lofwall MR, Extended-release injection vs sublingual buprenorphine for opioid use disorder with fentanyl use: A post hoc analysis of a randomized clinical trial. JAMA Netw Open. 2024; 7: e2417377– e2417377. 38916892 PMC11200143 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationXerostomia and impaired immune function may promote dental caries, tooth decay, and tooth loss, and these effects may be dose dependent.
“Commonly prescribed full opioid agonists such as hydrocodone and oxycodone are known to cause xerostomia13 and can impair immune function,14 both of which may promote dental caries, tooth decay and tooth loss, and these effects may be dose dependent.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [13] Götrick B, Åkerman S, Ericson D, Oral pilocarpine for treatment of opioid-induced oral dryness in healthy adults. J Dent Res. 2004; 83: 393– 397. 15111631
Not checked in the free run.
- cites [14] Ninković J, Roy S. Role of the mu-opioid receptor in opioid modulation of immune function. Amino Acids. 2013; 45: 9– 24. 22170499 PMC3912755
Not checked in the free run.
May combine two claims.
PremisecitationPoor nutritional habits, malnutrition, and social consequences of opioid use disorder such as homelessness and food insecurity are significant barriers to oral health and other positive behavioral routines.
“Poor nutritional habits, malnutrition, and OUD-associated social consequences such as homelessness and food insecurity pose significant barriers to oral health and other positive behavioral routines11 that may be mitigated by buprenorphine treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Chavez MN, Rigg KK. Nutritional implications of opioid use disorder: A guide for drug treatment providers. Psychol Addict Behav. 2020; 34: 699– 707. 32202820 source
Not checked in the free run.
May combine two claims.
PremisecitationEtminan and colleagues' study had two main limitations: missing patient oral hygiene information and inability to determine prescription indication, which left open the possibility that some patients were treated for chronic pain without opioid use disorder.
“Omission of patient oral hygiene information and inability to determine indication for prescriptions—exposing the possibility that some patients might have been treated for chronic pain without OUD—were noted as primary limitations.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Etminan M, Rezaeianzadeh R, Kezouh A, Association between sublingual buprenorphine-naloxone exposure and dental disease. JAMA. 2022; 328: 2269– 2271. 36511932 PMC9856241 source
Not checked in the free run.
May combine two claims.
PremisecitationFull opioid agonists are associated with hypogonadism and osteoporosis, which can cause dental problems.
“Furthermore, full opioid agonists are associated with hypogonadism and osteoporosis,15 which can cause dental problems.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Daniell HW. Opioid osteoporosis. Arch Intern Med. 2004; 164: 338– 338. 14769633
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe FDA warning stated that buprenorphine's benefits clearly outweigh its oral health risks.
“Critically, the FDA warning declared that benefits of buprenorphine use clearly outweigh the oral health risks.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Knopf A. FDA warns about dental problems with buprenorphine medicines dissolved in the mouth. Brown Univ Child Adolescent Psychopharmacol Update. 2022; 24: 8.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSeveral treatment societies asked for the FDA warning to be retracted because they worried it could reduce use of a life-saving treatment.
“Several treatment societies have asked for retraction of the FDA warning, noting concerns about its potential impact on use of a life-saving treatment.7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] American Academy of Addiction Psychiatry, American College of Academic Addiction Medicine, American College of Medical Toxicology, Re: A call for the FDA to retract its safety communication regarding buprenorphine. Published January 24, 2022. Accessed November 6, 2024. https://amersa.org/wp-content/uploads/22.01.24%20A%20Call%20for%20the%20FDA%20to%20Retract%20its%201.12.2022%20Safety%20Communication%20Regarding%20Buprenorphine.pdf
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationThe FDA warning rested on about 300 case reports that were anecdotal, which raised questions about how much disease occurrence could be attributed to TMB exposure.
“However, the anecdotal nature of the approximately 300 case reports supporting the warning raised questions about attributable risk—defined as the proportion of the disease occurrence that can be attributed to a certain exposure of TMB—that subsequent studies have sought to elucidate.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Knopf A. FDA warns about dental problems with buprenorphine medicines dissolved in the mouth. Brown Univ Child Adolescent Psychopharmacol Update. 2022; 24: 8.
Not checked in the free run.
The paper relies on this without support.
Findings from rats given buprenorphine can be generalized to humans for assessing oral health risk.
“Taking a vastly different approach, Zheng and colleagues explored mechanisms of oral health risk by exposing rats to transmucosal or intravenous buprenorphine.”
“Applying advanced quasi-experimental and mechanism-exploring methods, these 2 studies distinctly advance the plausibility of a causal relationship between TMB and oral health problems that underscores the urgency of testing risk-mitigating measures.”
The paper relies on this without support.
Streptococcus mutans is the primary agent in tooth decay.
“a condition proposed to increase risk for biofilm formation of Streptococcus mutans, the primary agent in tooth decay.”
Cites
Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018) · Annals of Internal Medicine · doi:10.7326/m17-3107 · Cited by 1,076 · see citing works
Buprenorphine for the management of opioid withdrawal
Gowing, L., Ali, R., & White, J. M. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002025.pub4 · Cited by 297 · see citing works
Role of the mu-opioid receptor in opioid modulation of immune function
Ninković, J., & Roy, S. (2013) · Amino Acids · doi:10.1007/s00726-011-1163-0 · Cited by 196 · see citing works
Greenwald, M. K., Comer, S. D., & Fiellin, D. A. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.07.035 · Cited by 174 · see citing works
Daniell, H. W. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.3.338-a · Cited by 52 · see citing works
Oral pilocarpine for treatment of opioid-induced oral dryness in healthy adults
Götrick, B., Åkerman, S., Ericson, D., Torstenson, R., & Tobin, G. (2004) · Journal of Dental Research · doi:10.1177/154405910408300508 · Cited by 41 · see citing works
Nutritional implications of opioid use disorder: A guide for drug treatment providers
Chavez, M. N., & Rigg, K. K. (2020) · Psychology of Addictive Behaviors · doi:10.1037/adb0000575 · Cited by 38 · see citing works
Nunes, E. V., Comer, S. D., Lofwall, M. R., Walsh, S. L., Peterson, S., Tiberg, F., Hjelmstrom, P., & Budilovsky-Kelley, N. R. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.17377 · Cited by 25 · see citing works
Association between sublingual buprenorphine-naloxone exposure and dental disease
Etminan, M., Rezaeianzadeh, R., Kezouh, A., & Aminzadeh, K. (2022) · JAMA · doi:10.1001/jama.2022.17485 · Cited by 25 · see citing works
FDA warns about dental problems with buprenorphine medicines dissolved in the mouth
Knopf, A. (2022) · The Brown University Child & Adolescent Psychopharmacology Update · doi:10.1002/cpu.30656 · Cited by 3 · see citing works
Sublingual buprenorphine-naloxone exposure and dental disease—Reply
Etminan, M., & Rezaeianzadeh, R. (2023) · JAMA · doi:10.1001/jama.2023.1504 · Cited by 1 · see citing works
Flagged first, then by citations
3 of the 14 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Mariolis, 2019, A systematic review of the effectiveness of buprenorphine for opioid use disorder compared to other treatments: Implications for research and practice, J Addict Res Ther, 10, 379
Cited by
Sorted by citations
Wang, T., Singh, R., Chen, J., Wang, B.-Y., Du, T., Hu, M., & Sun, R. (2026) · International Journal of Pharmaceutics · doi:10.1016/j.ijpharm.2026.127422
- Authors
- Black, A. C., & Becker, W. C.
- Affiliations
- Yale University (US)
- Corresponding author
- Black, Anne C.
- Venue
- Journal of Addiction Medicine
- Published
- 2025-03-11
- Volume
- 19
- Issue
- 5
- Pages
- 507-509
- ISSN
- 1932-0620 (ISSN-L)
- 1935-3227
- PMC
- PMC12210154
- OpenAlex
- W4408302066
- Cited by
- 1
- References
- 14
- Citations by year
- 2026: 1
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Addiction Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (U24DA058673, RM1DA055310)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid use disorder, oral health, dental caries, sublingual administration, salivary glands, FDA warning, oral hygiene, long-acting injectable buprenorphine, opioid overdose
- MeSH terms
- Analgesics, Opioid, Animals, Buprenorphine, Humans, Narcotic Antagonists, Opioid-Related Disorders, Rats
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-30.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-30.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
