Outpatient Cross-Titration to Buprenorphine for Chronic Pain

Area of Science:

• Pain Management
• Pharmacology
• Addiction Medicine

Background:

• Limited research exists on micro-induction of buprenorphine for chronic pain patients transitioning from full opioid agonists.
• The ongoing opioid epidemic necessitates effective strategies for converting patients to buprenorphine.

Purpose of the Study:

• To provide guidance on buprenorphine goal dosages for chronic pain patients.
• To outline a safe cross-titration protocol for converting patients from full opioid agonists to buprenorphine.

Main Methods:

• A cross-titration protocol was implemented for patients converting to buprenorphine.
• Patient data on induction duration, final buprenorphine dosage, and previous opioid use were collected.

Main Results:

• Approximately 48% (15/31) of patients successfully converted to buprenorphine and continued treatment at 4 weeks.
• The average induction duration was 29 days, with an average final buprenorphine/naloxone dose of 7.9 ± 5.7 mg/day.
• Patients previously on >120 mg Morphine Equivalent Daily Dose (MEDD) stabilized on 8-16 mg/day of buprenorphine.

Conclusions:

• Clinical responses to the buprenorphine cross-titration protocol were highly variable.
• Many patients required a slower titration and higher final buprenorphine dose than initially expected.
• Further research is needed to identify factors influencing response variability and refine the protocol.