C11 Buprenorphine Pharmacology and Patient Case Series of Rapid and Comfortable Ambulatory Transitions to Buccal Buprenorphine

Abstract

Buprenorphine (Butrans, Belbuca), a partial opioid agonist, is FDA-approved to treat chronic pain and offers several benefits over treatment with full-agonist opioids. The advantages of buprenorphine for chronic pain include significantly reduced risk of respiratory depression and other side effects, and excellent analgesia.1,2 Current literature exists on transitioning patients from full opioid agonists to buccal buprenorphine (BBUP, Belbuca).3 However, there is a paucity of data on transitioning to BBUP in an ambulatory setting. Tapering to a lower morphine equivalent dose (MED) in outpatient settings is difficult, as patients fear withdrawal and increased pain. This case series describes a method of transitioning to BBUP overnight. Methods This case series presents five patients diagnosed with chronic pain syndrome of various origin and length of chronic opioid analgesic therapy. IRB and patient consent obtained. Prior MED of 67.5 to 285 mg was converted to BBUP induction doses of 150 to 300 mcg. Patients stopped their opioid medication the night before induction. Vital signs and clinical opiate withdrawal scale (COWS) were assessed, and then one-half film of BBUP was administered.4 The assessment and dose were repeated in two hours. Patients departed one hour later after a final assessment. Results All patients experienced mild to moderate withdrawal symptoms, and two patients required clonidine during the appointment. COWS scores decreased to 1-7 points for all patients before departure. No patients required additional medical attention nor higher level of care for withdrawal symptoms. Conclusions Patients can rapidly and safely transition to BBUP in an ambulatory clinic setting. This limits the time a patient experiences discomfort from withdrawal and unmanaged pain, and improves their medication safety profile. Acknowledgements The authors report no disclosures.