Low-Dose Buprenorphine Initiation in Acute Burn Setting, a Retrospective Chart Review

Opioid use disorder (OUD) is a significant cause of unintentional burn injuries. Pain management in patients with OUD requires complex multi-modal treatment and places significant challenges on the patient and their clinical team. Buprenorphine has been well-established as a standard of care in the medical treatment of opioid use disorder. However, its use in surgical patients with significant co-morbid pain was felt to carry a risk for both worsened acute pain control and/or precipitation of withdrawal. As treatment with buprenorphine carries considerable benefits, alternative approaches have been developed to facilitate buprenorphine introduction in the acute perioperative setting. We present a first-ever retrospective cohort review examining the use of low-dose buprenorphine in acute burn injury setting. The majority of our patient cohort (86%) was able to initiate buprenorphine without an adverse impact on pain, or emergence of precipitated withdrawal. All of these patients were able to transition to outpatient OUD care for buprenorphine prescribing. Incidentally, we also note that buprenorphine initiation was also associated with reduced opioid prescribing at discharge, with only 50% of our patient cohort requiring a brief short-acting taper in addition to buprenorphine. Further studies should address long-term outcomes in the patient population as well as how to best holistically manage patients with substance use disorder and concurrent burn injuries.