Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter August 30, 2013

Buprenorphine in the treatment of non-suicidal self-injury: a case series and discussion of the literature

  • Lisa J. Norelli EMAIL logo , Howard S. Smith , Leo Sher and Tracey A. Blackwood


A global public health problem, non-suicidal self-injury (NSSI) is highly prevalent in both males and females, and tends to first occur in adolescence. NSSI is correlated with a history of childhood trauma, and with a variety of developmental and psychiatric disorders. NSSI is associated with increased risk of morbidity and premature death from suicide, accidents, and natural causes. Current treatment approaches are inadequate for a substantial number of people. Converging evidence for opioid system dysregulation in individuals with NSSI make this a promising area of investigation for more effective treatments. The pharmacological profile of buprenorphine, a potent μ-opioid partial agonist and κ-opioid antagonist, suggests that it may be beneficial. In this paper, we describe the successful treatment of severe NSSI with buprenorphine in six individuals, followed by discussion and further recommendations.

Corresponding author: Lisa J. Norelli, MD, MPH, Capital District Psychiatric Center, 75 New Scotland Avenue, Albany, NY 12208, USA


1. Jacobson CM, Gould M. The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: a critical review of the literature. Arch Suicide Res 2007;11:129–47.10.1080/13811110701247602Search in Google Scholar PubMed

2. Sinclair J, Gray A, Rivero-Arias O, Saunders K, Hawton K. Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatr Psychiatric Epidemiol 2011;46:263–71.10.1007/s00127-010-0183-5Search in Google Scholar PubMed

3. Whitlock J, Knox KL. The relationship between self-injurious behavior and suicide in a young adult population. Arch Pediatr Adolesc Med 2007;161:634–40.10.1001/archpedi.161.7.634Search in Google Scholar PubMed

4. Glenn CR, Klonsky ED. Prospective prediction of nonsuicidal self-injury: a 1-year longitudinal study in young adults. Behav Ther 2011;42:751–62.10.1016/j.beth.2011.04.005Search in Google Scholar PubMed PubMed Central

5. Hawton K, Fagg J. Suicide, and other causes of death, following attempted suicide. Br J Psychiatry 1988;152:359–66.10.1192/bjp.152.3.359Search in Google Scholar PubMed

6. Herpertz S. Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand 1995;91:57–68.10.1111/j.1600-0447.1995.tb09743.xSearch in Google Scholar PubMed

7. Zlotnick C, Mattia JI, Zimmerman M. Clinical correlates of self-mutilation in a sample of general psychiatric patients. J Nerv Ment Dis 1999;187:296–301.10.1097/00005053-199905000-00005Search in Google Scholar PubMed

8. Briere J, Gil E. Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 1998;68:609–20.10.1037/h0080369Search in Google Scholar PubMed

9. Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 2003;160:1501–8.10.1176/appi.ajp.160.8.1501Search in Google Scholar PubMed PubMed Central

10. Norelli LJ, Coates AD, Kovasznay BK. Cancer risk from diagnostic radiology in a deliberate self-harm patient. Acta Psychiatr Scand 2010;122:427–30.10.1111/j.1600-0447.2010.01538.xSearch in Google Scholar PubMed

11. Selby EA, Bender TW, Gordon KH, Nock MK, Joiner TE Jr. Non-suicidal self-injury (NSSI) disorder: a preliminary study. Personal Disord 2012;3:167–75.10.1037/a0024405Search in Google Scholar PubMed

12. Nonsuicidal self-injury. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing, 2013: 783–808.Search in Google Scholar

13. Moscicki EK, O Carroll P, Rae DS, Locke BZ, Roy A, et al. Suicide attempts in the Epidemiologic Catchment Area Study. Yale J Biol Med 1988;61:259–68.Search in Google Scholar

14. Schmidtke A, Bille-Brahe U, De Leo D, Kerkhof A, Bjerke T, et al. Attempted suicide Europe: rates, trends, and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 1996;93:327–38.10.1111/j.1600-0447.1996.tb10656.xSearch in Google Scholar PubMed

15. Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychol Res 2006;144:65–72.10.1016/j.psychres.2006.05.010Search in Google Scholar PubMed

16. Sher L, Stanley BH. The role of endogenous opioids in the pathophysiology of self-injurious and suicidal behavior. Arch Suicide Res 2008;12:299–308.10.1080/13811110802324748Search in Google Scholar PubMed

17. Prossin AR, Love TM, Koeppe RA, Zubeita J, Silk KR. Dysregulation of regional endogenous opioid function in borderline personality disorder. Am J Psychiatry 2010;167:925–33.10.1176/appi.ajp.2010.09091348Search in Google Scholar PubMed PubMed Central

18. Kennedy SE, Koeppe RA, Young EA, Zubeita J. Dysregulation of opioid emotion regulation circuitry in major depression in women. Arch Gen Psychiatry 2006;63:1199–208.10.1001/archpsyc.63.11.1199Search in Google Scholar PubMed

19. Mercer D. Medications in the treatment of borderline personality disorder 2006. Curr Psychiatry Rep 2007;9:53–62.10.1007/s11920-007-0010-1Search in Google Scholar PubMed

20. Bystritsky A, Strausser BP. Treatment of obsessive-compulsive cutting behavior with naltrexone. J Clin Psychiatry 1996;57:423–4.Search in Google Scholar

21. McGee MD. Cessation of self-mutilation in a patient with borderline personality disorder treated with naltrexone. J Clin Psychiatry 1997;58:32–3.10.4088/JCP.v58n0106eSearch in Google Scholar

22. Agarwal LJ, Berger CE, Gill L. Naltrexone for severe self-harm behavior: a case report. Am J Psychiatry 2011;168:437–8.10.1176/appi.ajp.2010.10101493Search in Google Scholar PubMed

23. Roth AS, Ostroff RB, Hoffman RE. Naltrexone as a treatment for repetitive self-injurious behaviour: an open-label trial. J Clin Psychiatry 1996;57:233–7.Search in Google Scholar

24. Kahan M, Srivastava A, Ordean A, Cirone S. Buprenorphine: new treatment of opioid addiction in primary care. Can Fam Physician 2011;57:281–9.Search in Google Scholar

25. Tzschentke TM. Behavioral pharmacology of buprenorphine, with a focus on preclinical models of reward and addiction. Psychopharmacology (Berl) 2002;161:1–16.10.1007/s00213-002-1003-8Search in Google Scholar PubMed

26. Ide S, Minami M, Satoh M, Uhl GR, Sora I, et al. Buprenorphine antinociception is abolished, but naloxone-sensitive reward is retained, in μ-opioid receptor knockout mice. Neuropsychopharmacology 2004;29:1656–63.10.1038/sj.npp.1300463Search in Google Scholar

27. Robinson SE. Buprenorphine: an analgesic with an expanding role in the treatment of opioid addiction. CNS Drug Rev 2002;8:377–90.10.1111/j.1527-3458.2002.tb00235.xSearch in Google Scholar

28. Wnendt S, Krüger T, Janocha E, Hildebrandt D, Englberger W. Agonistic effect of buprenorphine in a nociceptin/OFQ receptor-triggered gene assay. Mol Pharmacol 1999;56:334–8.10.1124/mol.56.2.334Search in Google Scholar

29. Bloms-Funke P, Gillen C, Schuettler AJ, Wnendt S. Agonistic effects of the opioid buprenorphine on the nociceptin/OFQ receptor. Peptides 2000;21:1141–6.10.1016/S0196-9781(00)00252-7Search in Google Scholar

30. Leander DJ. Opioid agonist and antagonist behavioral effects of buprenorphine. Br J Pharmacol 1983;78:607–15.10.1111/j.1476-5381.1983.tb09410.xSearch in Google Scholar

31. Bickel WK, Stitzer ML, Bigelow GE, Liebson IA, Jasinski DR, et al. Buprenorphine: dose-related blockade of opioid challenge effects in opioid-dependent humans. J Pharmacol Exp Ther 1988;247:47–53.Search in Google Scholar

32. Walker EA, Zernig G, Woods JH. Buprenorphine antagonism of μ opioids in the rhesus monkey tail-withdrawal procedure. J Pharmacol Exp Ther 1995;273:1345–52.Search in Google Scholar

33. Woods JH, France CP, Winger GD. Behavioral pharmacology of buprenorphine: issues relevant to its potential in treating abuse. NIDA Res Monogr 1992;121:12–27.Search in Google Scholar

34. Cowan A, Lewis JW, MacFarlane IR. Agonist and antagonist properties of buprenorphine, a new antinociceptive agent. Br J Pharmacol 1977;60:537–45.10.1111/j.1476-5381.1977.tb07532.xSearch in Google Scholar

35. Dum JE, Herz A. In vivo receptor binding of the opiate partial agonist, buprenorphine, correlated with its agonistic and antagonistic actions. Br J Pharmacol 1981;74:627–33.10.1111/j.1476-5381.1981.tb10473.xSearch in Google Scholar

36. Villiger J, Taylor K. Buprenorphine: characteristics of binding sites in the rat central nervous system. Life Sci 1981;29: 2699–708.10.1016/0024-3205(81)90529-4Search in Google Scholar

37. Boas R, Villiger J. Clinical actions of fentanyl and buprenorphine. Br J Anaesth 1985;57:192–6.10.1093/bja/57.2.192Search in Google Scholar

38. Rance MJ, Dickens JM. The influence of drug-receptor kinetics on the pharmacological and pharmacokinetic profiles of buprenorphine. In: Van Ree J, Terenius L, editors. Characteristics and functions of opioids. Amsterdam: Elsevier, 1978:65–6.Search in Google Scholar

39. Mello NK, Bree MP, Mendelson JH. Buprenorphine self administration by rhesus monkeys. Pharmacol Biochem Behav 1981;15:215–25.10.1016/0091-3057(81)90180-5Search in Google Scholar

40. Dykstra LA. Behavioral effects of buprenorphine and diprenorphine under a multiple schedule of food presentation in squirrel monkeys. J Pharmacol Exp Ther 1983;226:317–23.Search in Google Scholar

41. France CP, Jacobson AE, Woods JH. Discriminative stimulus effects of reversible and irreversible opiate agonists: morphine, oxymorphazone and buprenorphine. J Pharmacol Exp Ther 1984;230:652–7.Search in Google Scholar

42. France CP, Woods JH. Opiate agonist-antagonist interactions: application of a three-key drug discrimination procedure. J Pharmacol Exp Ther 1985;234:81–9.Search in Google Scholar

43. Young AM, Kapitsopoulos G, Makhay MM. Tolerance to morphine-like stimulus effects of μ opioid agonists. J Pharmacol Exp Ther 1991;257:795–805.Search in Google Scholar

44. Brandt MR, Cabansag SR, France CP. Discriminative stimulus effects of 1-α-acetylmethadol (LAAM), buprenorphine and methadone in morphine-treated rhesus monkeys. J Pharmacol Exp Ther 1997;282:574–84.Search in Google Scholar

45. Briscoe RJ, Winger G, Lewis JW, Woods JH. Methoclocinnamox: time course of changes in alfentanil reinforced responding in rhesus monkeys. Psychopharmacology 2000;148:393–9.10.1007/s002130050068Search in Google Scholar PubMed

46. Mogil JS, Wilson SG, Chesler EJ, Rankin AL, Nemmani KV, et al. The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci USA 2003;100:4867–72.10.1073/pnas.0730053100Search in Google Scholar PubMed PubMed Central

47. Steiner H, Gerfen CR. Role of dynorphin and enkephalin in the regulation of striatal output pathways and behavior. Exp Brain Res 1998;123:60–76.10.1007/s002210050545Search in Google Scholar PubMed

Received: 2012-10-16
Accepted: 2012-12-1
Published Online: 2013-08-30
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

Downloaded on 4.6.2023 from
Scroll to top button