Comparing Maintenance Therapy Achievement for Opioid-Experienced Patients Converted to Buprenorphine for Chronic Pain Management.

Abstract

Treatment of chronic, non-cancer pain can be challenging in the presence of long-term opioid therapy (LTOT). Buprenorphine products can provide a unique option for chronic pain treatment due to the improved safety profile with a ceiling effect on respiratory depression. Drug manufacturers provide recommendations for conversion from full mu agonist to buprenorphine which typically includes tapering to lower morphine equivalent doses (MEDD). This study will attempt to compare if there is a difference in the ability of achieving buprenorphine maintenance therapy for chronic pain based on the starting opioid MEDD. This study's primary endpoint is the difference in ability to achieve buprenorphine maintenance therapy for chronic, non-cancer pain based on baseline MEDD (i.e., ≤30 MEDD vs >30 MEDD). Secondary endpoints will describe method of conversion to buprenorphine, difference in frequency of follow up and average time to achieve maintenance doses. There was no difference in ability to achieve buprenorphine maintenance doses between either group. Approximately 40% of patients in each group achieved maintenance doses regardless of baseline MEDD. Patients on higher MEDDs had the same likelihood of achieving buprenorphine maintenance therapy for chronic pain as those were at 30 MEDD and can be considered for buprenorphine therapy without tapering first.