The use of buprenorphine/naloxone to treat borderline personality disorder: a case report

Background: Using traditional pharmacotherapy to treat Borderline Personality Disorder (BPD) such as mood stabilizers and second-generation antipsychotics has a lack of supporting evidence. Buprenorphine/Naloxone (BUP/N), a combination medication consisting of a partial opioid agonist, and a full opioid antagonist, is an effective treatment for opioid use disorder. It has also been found effective for treatment-resistant mood disorders. Previous studies suggest a relationship between BPD and endogenous opioids, therefore our case report investigates the effect of BUP/N on a patient diagnosed with BPD. Case presentation: A 26-year-old female diagnosed with BPD, having recurrent visits to the emergency department (ED) for self-harm/suicidality was treated with BUP/N. Usage of crisis services, ED visits, and hospital admissions were tracked from 15 months prior to BUP/N to 15 months after using BUP/N. Since starting BUP/N, the length and frequency of mental health-related hospital admissions decreased drastically, as did the number of times that she reached out to community crisis services. Since the dosing adjustment to 6 mg in Oct 2020, there have been no calls to the community crisis lines. Conclusions: We suggest pharmacological treatment targeting BPD as a disorder of distress tolerance and self-soothing mediated by the opioid system is an effective individual healing attempt. An important note is that this patient did not use opioids prior to BUP/N and had never been diagnosed with an opioid use disorder. However, she exhausted multiple other pharmacologic therapies and was open to trying whatever was available to improve her quality of life.