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CLICK HERE for Live Video Presentation December 16, 2021 at 2:30pmET

Buprenorphine Update – Intracellular Nuances of Buprenorphine

Gregory Acampora, MD

A detailed review and update on Buprenorphine as well as a detailed look at the intra-cellular nuances of buprenorphine that makes this molecule so special.

This presentation is from BUPE2021, and CME credits are not available for it. However, it still has excellent learning value.

Presentation Slide Handouts: Presentation Handouts

Pharmacists Role in Buprenorphine Management for Opioid Use Disorder

Jacqueline Cleary, PharmD, BCACP
Amanda Winans, PharmD, BCPS
Amanda Engle, PharmD, BCPS

The continued escalation of patients treated for opioid use disorder (OUD) has called for an increase in access to OUD therapies. Pharmacists have previously demonstrated value in collaborative treatment of various disease states and have recently begun to address gaps in OUD care by facilitating buprenorphine therapy. This presentation will review current literature describing the pharmacist’s role in facilitating buprenorphine as part of the OUD care team. Studies were included in the review if a pharmacist was part of a care model in which buprenorphine was prescribed for OUD and excluded if there was a pain management indication for therapy, a limited pharmacist role, or a survey methodology used. Key characteristics identified include: 1) Pharmacist Role 2) Collaborating Prescriber Type 3) Clinic Setting 4) Pharmacist Practice Type and 5) Outcomes. Findings revealed that pharmacists are a valued member of buprenorphine care teams across a variety of settings and have a positive impact on important patient outcomes such as treatment retention and relapse. Few published collaborative care models exist, suggesting pharmacists may be underutilized in caring for this expanding patient population. Pharmacists are well prepared to take a more active role in buprenorphine management to help address the enduring opioid crisis.

This presentation is from BUPE2021, and CME credits are not available for it. However, it still has excellent learning value.

Presentation Slide Handouts: Presentation Handouts

Facilitating discontinuation of intravenous opioids by concurrent use of sublingual buprenorphine
with rapid microdosing induction: A pain management case study

Taylor Purvis, MD

Co-authors on the original paper: Arjun Tara, DO; Gregory Acampora, MD; Jingping Wang, MD, PhD; Karina De Sousa, BS; Yi Zhang, MD, PhD

We report a case in which sublingual buprenorphine was used to help transition a patient off intravenous (IV) opioid analgesics medications post-multiple abdominal procedures. Intravenous opioids are commonly used in inpatient surgical pain management for patients with severe pain who are unable to take oral medications. Typically, a short course of IV analgesics is used, followed by transition to oral analgesic regimen. However, in patients with poor gastrointestinal absorption, pain control can be challenging. We present this case to highlight how sublingual buprenorphine can be a useful agent for acute pain management, especially when conventional strategies provide sub-optimal responses.

This presentation is from BUPE2021, and CME credits are not available for it. However, it still has excellent learning value.

Presentation Slide Handouts: Presentation Handouts

The divided dose approach to perioperative buprenorphine management in patients with opioid use disorder

Amanda L. Engle, PharmD, Amanda R.M. Winans, PharmD, Linda Demma, MD, PhD, Jacqueline Cleary, PharmD

There is limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management in patients with opioid use disorder. As such, we aimed to develop a standardized perioperative management approach with the goals of (1) optimizing perioperative analgesia, (2) minimizing relapse risk, (3) setting expectations for patients and clinicians, (4) achieving prescribing consistency and mitigating risk among clinicians not familiar with perioperative buprenorphine management, and (5) maintaining continuity throughout care transitions. An interprofessional expert focus group convened to develop a consensus algorithm based upon buprenorphine’s unique pharmacologic features and published perioperative management recommendations. The resulting consensus algorithm continues the patient’s home buprenorphine dose in order to minimize relapse risk, but utilizes a divided dose approach starting the day of surgery if moderate to severe post-operative pain is expected. This strategy leverages the analgesic effects of buprenorphine while allowing for additional opioid binding to optimize analgesia. A patient-centered multimodal perioperative approach including local and/or regional anesthetics and nonopioid adjuncts is employed. Post-operative care is optimized by preoperative planning, including standardized patient assessment, perioperative communication with the buprenorphine prescriber, and education for patients and clinicians. Overall, integrating an understanding of pharmacology and clinical impact through the use of a readily adaptable algorithm
such as the divided dose approach is key to optimizing patient care in this high-risk population.

This presentation is from BUPE2021, and CME credits are not available for it. However, it still has excellent learning value.

1. Larochelle MR, Bernson D, Land T, et al.: Medication for opioid use disorder after nonfatal opioid overdose and association
with mortality: A cohort study. Ann Intern Med. 2018; 169: 137-145. DOI: 10.7326/M17-3107.
2. Mattick RP, Breen C, Kimber J, et al.: Buprenorphine maintenance versus placebo or methadone maintenance for opioid
dependence. Cochrane Database Syst Rev. 2014; 2: CD002207.
3. Atluri S, Sudarshan G, Manchikanti L: Assessment of the trends in medical use and misuse of opioid analgesics from
2004 to 2011. Pain Phys. 2014; 2(17): E119-E128.
4. Moore DJ: Nurse practitioners’ pivotal role in ending the opioid epidemic. J Nurs Pract. 2019; 15: 323-327.
5. HHS.gov: HHS expands access to treatment for opioid use disorder. 2021. Available at https://www.hhs.gov/about/
news/2021/01/14/hhs-expands-access-to-treatment-for-opioiduse-disorder.html. Accessed January 19, 2021.

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DOI: 10-5055-bupe-21-rp-0055

Managing the Complexities of Treating Older Adults with Longstanding Chronic Pain
or Opioid Use Disorder with Buprenorphine and Integrative Health

Juliette Perzhinsky, MD, MSc, FACP
John Hopper, MD, DFASAM, FACP, FAAP
David Gaffney, LMSW, BCDCH

The chronic use of full opioid agonists presents risks to aging adults, especially since the longstanding use of opioids for chronic pain is associated with tolerance, along with opioid misuse, opioid use disorder (OUD), and inadvertent respiratory depression. Older adults are particularly at a high risk of complications given a higher prevalence of physical and mental health co-morbidities. Buprenorphine, used off-label for pain management, as a safer option, likely requires additional therapeutic resources to assist geriatric patients in this transition.

This presentation is from BUPE2021, and CME credits are not available for it. However, it still has excellent learning value.

Presentation Slide Handouts: Presentation Handouts