Managing Cancer-Related Pain in Patients Receiving Long-Acting Buprenorphine for Opioid Use Disorder

Buprenorphine has been shown to significantly reduce opioid related harms, with two injectable extended-release formulations being increasingly used for the management of opioid use disorder (OUD). Palliative care clinicians are encountering more patients with OUD and must familiarize themselves with the unique considerations of the injectable extended-release formulations of buprenorphine. Additionally, the management of cancer-related pain in patients treated with injectable buprenorphine formulations is complex, and guidelines are limited, particularly around the use of full opioid agonists. Here, we explore a composite case study of a 62-year-old man with severe OUD that is well managed on injectable buprenorphine, who is later diagnosed with cancer and develops cancer-related pain, as a basis for a discussion about the management approach in cases similar to this one. Major clinical takeaways are the importance of continuing to prioritize OUD management while also considering the pharmacokinetic profile of extended-release buprenorphine formulations, with particular attention to receptor availability for full opioid agonists and the half-life of buprenorphine formulations. Additionally, it is central to OUD and cancer-related pain management to utilize multimodal analgesia and a multidisciplinary team approach. In light of the lessons learned based on clinical practice and surrounding literature review, we recommend that palliative care teams iteratively balance pain and OUD management needs.