Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist: Patient Priority at the Interface Between Medical Disciplines.

Publication date: Jan 07, 2020

Buprenorphine is a partial-agonist opioid that is prescribed as a medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor affinity and binding coefficient; when buprenorphine is administered simultaneously with a ?-opioid receptor full agonist (“full agonist opioid” [FAO]), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacologic management that necessitates the use of FAO. When patients receiving buprenorphine-MAT (BUP-MAT) formulations have presented for operative procedures, there has been clinical variance in approach to their BUP-MAT management. Recognizing the risk management challenge from both analgesia and BUP-MAT perspectives, we convened a multidisciplinary group of clinicians who treat BUP-MAT patients and completed a literature review with the goal of generating a guideline for appropriate management of these patients presenting for a broad spectrum of surgical procedures. Our conclusion is that continuous simultaneous administration of buprenorphine products with FAO is safe when accounting for dose and timing, including surgeries that historically produce moderate to severe pain, and may further provide an analgesic advantage, lessen FAO burden, and reduce relapse risk to this group.

Open Access PDF

Acampora, G.A., Nisavic, M., and Zhang, Y. Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist: Patient Priority at the Interface Between Medical Disciplines. 04486. 2020 J Clin Psychiatry (81):1.

Concepts Keywords
Accounting Buprenorphine
Agonist Ethers
Analgesia RTT
Analgesic Drug rehabilitation
Buprenorphine Phenols
FAO Morphinans
Full Agonist Analgesics
Opioid Drugs
Opioid Receptor Opioids
Opioid Receptor Agonist Guideline management
Pain Relapse risk
Partial Agonist Administration buprenorphine products
Pharmacologic Pharmacologic management
Receptor Affinity Agonist
Relapse Opioid use disorder
Risk Management Pain ladder
Spectrum
Variance

Semantics

Type Source Name
drug DRUGBANK Buprenorphine
drug DRUGBANK Ilex paraguariensis leaf
disease MESH relapse

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