Buprenorphine: A life-saving medication that’s being overlooked in the opioid crisis

Buprenorphine: A life-saving medication that’s being overlooked in the opioid crisis

Publication date: Apr 13, 2019

Methadone and buprenorphine are well established treatments for opioid addiction (now known as -opioid use disorder”), and both drugs are also used for treating pain.

Methadone had long been a favorite among pain and palliative care physicians when treating patients with pain in the context of a serious illness, like cancer or HIV/AIDS, or for patients on methadone for maintenance therapy, or with a history of opioid addiction, to mitigate risk of future opioid abuse.

Unlike methadone and all other opioids, patients on buprenorphine can tolerate increasing doses of the drug without causing respiratory depression, which is how individuals die from an opioid overdose.

When I mention these benefits of buprenorphine to my colleagues, I get the same response: -Why don’t we just treat chronic pain patients with buprenorphine and avoid all the problems with opioids?”

To be sure, there is no evidence that buprenorphine is superior to other opioids or should be used as the preferred medication for debilitating, chronic pain.

That being said, in my clinical experience and that of my pain and palliative care colleagues who prescribe buprenorphine for chronic pain, we have observed excellent pain control in the majority of patients, consistent with published studies, with no observed behaviors suggestive of addiction, and no opioid overdoses.

Further, as buprenorphine is not a familiar pain medication for clinicians outside of pain medicine and palliative care, a nation-wide clinical educational program would need to be developed to insure proper dosing, prescribing, dispensing, and monitoring patients when this drug is used for pain, as opposed to solely treating addiction, which requires a separate DEA waiver.

While a balanced public health strategy to address the opioid epidemic requires – at a minimum – systematic monitoring of inappropriate opioid prescribing, increased access to mental health and addiction programs, harm reduction and preventive strategies, and education of clinicians treating chronic pain; the use of buprenorphine should not be overlooked.

Concepts Keywords
Addiction Pain management
AIDS Dialysis
Analgesic Methadone
Brain Opioid use disorder
Buprenorphine Buprenorphine
Cancer Morphinans
Cancer Pain Drug rehabilitation
CDC RTT
Chronic Pain Euphoriants
Cognitive Dysfunction Dialysis
Columbia Center Opioids
DEA Drugs
Dialysis HIV
Fentanyl Sudden cardiac death
Harm Reduction Pain management
Heroin Buprenorphine chronic pain
HIV Opioids chronic pain
Hormone Respiratory depression
Immune Suppression AIDS
Kidney Failure Opioid disorder
Methadone Pain
Mortality Pain management
Muscular Dystrophy
National Assembly
NIH
Opioid
Opioid Addiction
Opioid Dependence
Opioid Epidemic
Opioid Overdose
Opioids
Overdose
Pain
Pain Management
Pain Medication
Pain Medications
Pain Reliever
Palliative Care
Pharmaceutical Companies
Pharmacological
Pharmacy
Respiratory Depression
Sickle
Spinal Cord
Sudden Cardiac Death
Suicide
Testosterone
Tricky
Withdrawal Syndrome

Semantics

Type Source Name
disease DOID syndrome
disease MESH syndrome
drug DRUGBANK Tropicamide
disease DOID kidney failure
disease MESH kidney failure
disease MESH sickle cell disease
disease MESH respiratory depression
disease MESH cognitive dysfunction
drug DRUGBANK Testosterone
disease DOID muscular dystrophy
disease MESH muscular dystrophy
gene UNIPROT ACAT1
gene UNIPROT MAT1A
disease MESH drug interactions
disease MESH sudden cardiac death
disease DOID opioid abuse
disease MESH opioid abuse
disease DOID AIDS
disease MESH AIDS
drug DRUGBANK Methadone
gene UNIPROT BAD
gene UNIPROT SLAMF8
drug DRUGBANK Fentanyl
drug DRUGBANK Diamorphine
gene UNIPROT SMIM10L2A
gene UNIPROT SMIM10L2B
gene UNIPROT SSRP1
gene UNIPROT TLR4
disease MESH death
disease MESH suicide
disease MESH suffering
disease MESH chronic pain
disease DOID cancer
disease MESH cancer
gene UNIPROT PTPN5
drug DRUGBANK Buprenorphine

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