Joan Chong1, Matthew Frei2, Dan I Lubman3. 1. MBBS, FRACP, FAChAM, Addiction Medicine Specialist, Western Health and Melbourne Health, Vic. 2. MBBS, FAChAM, Clinical Director, Turning Point, Vic. 3. BSc (Hons), MBChB, PhD, FRANZCP, FAChAM, Director, Turning Point, Eastern Health, Vic; Professor of Addiction Studies, Monash University, Vic.
Abstract
BACKGROUND: Opioids are frequently used to manage chronic non-cancer pain despite the lack of evidence of benefit and clear evidence of opioid-related harms. Patients undergoing high-dose opioid therapy are at risk of multiple complications, such as opioid toxicity, including fatal overdose and opioid dependence. OBJECTIVE: This article provides an overview of the pharmacology of buprenorphine and reviews current evidence for the use of high-dose sublingual buprenorphine-naloxone in the pharmacological management of patients at high risk of complications from chronic opioid use. DISCUSSION: Buprenorphine-naloxone is well tolerated by patients with chronic pain, and has the potential to improve pain scores and affective symptoms. This is exemplified in a case study based on these authors' experience in an addiction medicine setting. As the rates of pharmaceutical opioid prescribing and related harms continue to increase in Australia, buprenorphine-naloxone is a viable option to manage high-risk chronic pain patients who are unable to reduce or cease their opioid use.
BACKGROUND: Opioids are frequently used to manage chronic non-cancer pain despite the lack of evidence of benefit and clear evidence of opioid-related harms. Patients undergoing high-dose opioid therapy are at risk of multiple complications, such as opioid toxicity, including fatal overdose and opioid dependence. OBJECTIVE: This article provides an overview of the pharmacology of buprenorphine and reviews current evidence for the use of high-dose sublingual buprenorphine-naloxone in the pharmacological management of patients at high risk of complications from chronic opioid use. DISCUSSION: Buprenorphine-naloxone is well tolerated by patients with chronic pain, and has the potential to improve pain scores and affective symptoms. This is exemplified in a case study based on these authors' experience in an addiction medicine setting. As the rates of pharmaceutical opioid prescribing and related harms continue to increase in Australia, buprenorphine-naloxone is a viable option to manage high-risk chronic painpatients who are unable to reduce or cease their opioid use.
Authors: Nicholas Avery; Amy G McNeilage; Fiona Stanaway; Claire E Ashton-James; Fiona M Blyth; Rebecca Martin; Ali Gholamrezaei; Paul Glare Journal: BMJ Date: 2022-04-04