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.
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