From Addiction to Acute Pain Relief: A Narrative Review on Buprenorphine's Expanding Role in Emergency Department...

Buprenorphine, a partial µ-opioid receptor agonist, has gained attention for its potential role in pain management across various clinical settings, including emergency departments (ED), perioperative care, and palliative care. Its unique pharmacological profile may offer advantages over traditional opioids, particularly in mitigating opioid-related complications.

This narrative review aims to synthesize current literature on the efficacy, safety, and clinical applications of buprenorphine for pain management, highlighting its use in acute pain contexts. The review also seeks to provide practical dosing and implementation recommendations informed by multidisciplinary expert opinion and existing evidence.

Buprenorphine presents several advantages which include its ceiling effect on respiratory depression, lower potential for misuse and addiction, and longer duration of sustained analgesia. The review discusses the diverse formulations of buprenorphine, including sublingual, transdermal, and intravenous options, and their respective roles in acute pain management. It addresses the limitations of current research, including the heterogeneity of study designs and the need for further ED based studies to establish robust clinical guidelines. Additionally, it examines barriers to buprenorphine's broader adoption, such as insurance coverage, stigma, and administrative challenges.

Buprenorphine represents a promising alternative to full opioid agonists for pain management, particularly in acute settings. Future research is essential to validate its efficacy and optimize its integration into acute care settings such as emergency departments.