An observational study of buprenorphine treatment of the prescription opioid dependent pain patient

Streltzer, Jon; Davidson, Raymond; Goebert, Deborah

doi:10.1111/ajad.12198

Cited by 14 publications

(33 citation statements)

References 25 publications

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“…86,87 This hypothesis was reflected in several studies included in the present systematic review, which focused on participants with aberrant use but excluded those with OUD. 54,55 JAMA Network Open | Substance Use and Addiction…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

et al. 2021

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IMPORTANCE Individuals with chronic pain who use long-term opioid therapy (LTOT) are at risk of opioid use disorder and other harmful outcomes. Rotation to buprenorphine may be considered, but the outcomes of such rotation in this population have not been systematically reviewed.OBJECTIVE To synthesize the evidence on rotation to buprenorphine from full μ-opioid receptor agonists among individuals with chronic pain who were receiving LTOT, including the outcomes of precipitated opioid withdrawal, pain intensity, pain interference, treatment success, adverse events or adverse effects, mental health condition, and health care use. EVIDENCE REVIEW PubMed, CINAHL, Embase, and PsycInfo were searched from inception through November 3, 2020, for peer-reviewed original English-language research that reported the prespecified outcomes of rotation from prescribed long-term opioids to buprenorphine among individuals with chronic pain. Two independent reviewers extracted data as well as assessed risk of bias and study quality according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) reporting guidelines. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. FINDINGS A total of 22 studies were analyzed, of which 5 (22.7%) were randomized clinical trials, 7 (31.8%) were case-control or cohort studies, and 10 (45.5%) were uncontrolled pre-post studies, which involved 1616 unique participants (675 female [41.8%] and 941 male [58.2%] individuals). Six of the 22 studies (27.3%) were primary or secondary analyses of a large randomized clinical trial.Participants had diverse pain and opioid use histories. Rationale for buprenorphine rotation included inadequate analgesia, intolerable adverse effects, risky opioid regimens (eg, high dose and/or sedative coprescriptions), and aberrant opioid use. Most protocols were adapted from protocols for initiating treatment in patients with opioid use disorder and used buccal or sublingual buprenorphine. Very low-quality evidence suggested that buprenorphine rotation was associated with maintained or improved analgesia, with a low risk of precipitating opioid withdrawal. Steadydose buprenorphine was better tolerated than tapered-dose buprenorphine. Adverse effects were manageable, and severe adverse events were rare. Only 2 studies evaluated mental health outcomes, but none evaluated health care use. Limitations included a high risk of bias in most studies. CONCLUSIONS AND RELEVANCEIn this systematic review, buprenorphine was associated with reduced chronic pain intensity without precipitating opioid withdrawal in individuals with chronic pain who were receiving LTOT. Future studies are necessary to ascertain the ideal starting dose, formulation, and administration frequency of buprenorphine as well as the best approach to buprenorphine rotation.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

et al. 2021

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“…The decision to stop taking opioid painkillers was not a spontaneous request on the part of the patient but a decision she took when she realized that no physician would prescribe her such a high daily dose. In the literature, it has been shown that replacing opioid medication with a substitution treatment of buprenorphine and buprenorphine-naloxone is effective for chronic pain and offers patients a good degree of satisfaction [32, 33]. However, as buprenorphine is off-label and buprenorphine-naloxone was off-label in France at this time, these treatments should be proposed only after withdrawal has been shown to have failed.…”

Section: Discussionmentioning

confidence: 99%

Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report

et al. 2016

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BackgroundOpioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal.Case presentationWe describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms.ConclusionKetamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.

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Section: Benefit-risk Assessment Of Buprenorphine Vs Conventional Opioidsmentioning

confidence: 99%

“…74 Patients with comorbid chronic pain and OUD have reported satisfaction with buprenorphine treatment. 75 Also, buprenorphine is not immunosuppressive, 76,77 does not negatively impact the [78][79][80] and may reduce anxiety and depression. [81][82][83][84] Overall, the safety data and additional benefits of buprenorphine suggest that it has a lower risk of adverse events compared with conventional opioids, most notably with respiratory depression.…”

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confidence: 99%

Benefit-Risk Analysis of Buprenorphine for Pain Management

Hale

Garofoli²,

Raffa³

2021

JPR

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Health care providers in the United States are facing challenges in selecting appropriate medication for patients with acute and chronic pain in the midst of the current opioid crisis and COVID-19 pandemic. When compared with conventional opioids, the partial µ-opioid receptor agonist buprenorphine has unique pharmacologic properties that may be more desirable for pain management. The formulations of buprenorphine approved by the US Food and Drug Administration for pain management include intravenous injection, transdermal patch, and buccal film. A comparison of efficacy and safety data from studies of buprenorphine and conventional opioids suggests that buprenorphine may be a better-tolerated treatment option for many patients that provides similar or superior analgesia. Our benefit-risk assessment in this narrative review suggests that health care providers should consider that buprenorphine may be an appropriate alternative for pain management over other opioids.

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An observational study of buprenorphine treatment of the prescription opioid dependent pain patient

Abstract: Buprenorphine is an effective tool when treating the opioid-dependent chronic pain patient.

Cited by 14 publications

References 25 publications

Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report

Benefit-Risk Analysis of Buprenorphine for Pain Management

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