Opioid-Induced Adrenal Insufficiency in a Patient Treated With Buprenorphine-Naloxone: A Case Report

With the rising clinical use of opioid agonist/antagonist medications for opioid use disorder (OUD), overlooked adverse events, such as adrenal insufficiency, are coming to the forefront. Opioid-induced adrenal insufficiency (OIAI) occurs when opioids dampen the hypothalamic-pituitary-adrenal (HPA) axis, leading to adrenal suppression. Opioid-induced adrenal insufficiency is associated with significant morbidity and can precipitate high-mortality adrenal crises. We present a case of a 33-year-old male patient, initially presenting with concern for gastrointestinal bleeding, in which Suboxone (buprenorphine/naloxone) was the likely culprit of a newly uncovered adrenal insufficiency.