J Am Pharm Assoc (2003). 2024 Feb 14:S1544-3191(24)00038-4. doi: 10.1016/j.japh.2024.02.008. Online ahead of print.
ABSTRACT
BACKGROUND: There is currently a clinical dilemma in treating acute pain in patients receiving buprenorphine products.
OBJECTIVE: This review aims to characterize buprenorphine management and associated outcomes at a Veterans Affairs Health Care System (VAHCS).
METHODS: This is a retrospective cohort review involving patients receiving buprenorphine therapy who also either underwent a surgical procedure or presented to a VAHCS emergency department (ED) for acute pain between January 1, 2012 and January 1, 2022. Patients were excluded if opioids were prescribed 30 days before the index date or if the buprenorphine prescription was written by a provider working external to the healthcare system. The primary objective was to characterize buprenorphine treatment strategies into 4 treatment approaches (i.e., increased, decreased, discontinued, or continued total daily doses (TDDs) of buprenorphine products). Secondary objectives were to asses 1) the incidence of opioid use disorder (OUD) relapse within 90 days from index date, 2) re-presentation to the hospital for pain or OUD within 90 days from discharge date, 3) fatal and non-fatal overdose within 90 days from index date, 4) all-cause mortality within 30 and 90 days from index date, and 5) suicidality at 30 and 90 days. Descriptive statistics were used to analyze study results.
RESULTS: A total of 70 of 259 patients that were screened met inclusion criteria. The mean (±SD) age was 50.3 ± 13 years, 92.9% were male, 64.3% were White, and 78.6% had an OUD diagnosis per problem list. While 84.3% presented to the ED, 15.7% underwent surgical procedures. The TDD of buprenorphine or buprenorphine/naloxone from index date to discharge was continued in 90.0% of cases, increased in 2.9% of cases, decreased in 1.4% of cases, and discontinued in 5.7% of cases. Approximately 46% of patients were prescribed an additional pain medication, with majority of these patients either receiving nonsteroidal anti-inflammatory drugs (46.7%) or full agonist opioids(36.7%). A total of 7.1% patients re-presented to the ED for pain or OUD relapse, 15.7% of patients with OUD relapsed, 1.4% developed new-onset suicidality, and 1.4% met the endpoint for all-cause mortality within 90 days of the index date. No fatal or non-fatal opioid overdoses were observed.
CONCLUSION: Our findings suggest that the most commonly observed practice to manage acute pain in a veteran population receiving buprenorphine or buprenorphine/naloxone was to continue buprenorphine doses. Although further data is necessary to fully elucidate these findings, the data herein may suggest that clinicians can safely continue buprenorphine doses in the setting of acute pain. Given the paucity of data to guide treatment approaches, larger scale trials are needed to identify optimal strategies on how to best manage acute pain in patients receiving buprenorphine products for pain or OUD.
PMID:38364887 | DOI:10.1016/j.japh.2024.02.008