Buprenorphine: Not a silver bullet, and still controversial


  • Sudheer Potru, DO, FASAM
  • Michael Sprintz, DO, DFASAM
  • Antje M. Barreveld, MD
  • Lynn Kohan, MD




buprenorphine, sustained-release


We are practitioners of pain medicine and addiction medicine and also four of the seven members of the Multi-Society Ad Hoc Substance Use Disorder (SUD) Working Group comprised of representatives from anesthesia, pain, pharmacy, and addiction medicine societies. We are finalizing “tip sheets” and a consensus-based manuscript to provide guidance on the appropriate use and initiation of buprenorphine in the hospital setting by anesthesiologists, and in the outpatient setting by pain clinicians.

Author Biographies

Sudheer Potru, DO, FASAM

Assistant Professor, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Michael Sprintz, DO, DFASAM

Founder, Sprintz Center for, Pain/Sprintz Center for Recovery, Assistant Clinical Professor, Division of Geriatrics and Palliative Medicine, University of Texas Health Science Center at, Houston, Houston, Texas

Antje M. Barreveld, MD

Assistant Professor, Department of Anesthesiology, Tufts University School of Medicine, Newton-Wellesley Hospital, Newton, Massachusetts

Lynn Kohan, MD

Associate Professor, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia



Chilcoat HD, Amick HR, Sherwood MR, et al.: Buprenorphine in the United States: Motives for abuse, misuse, and diversion. J Subst Abuse Treat. 2019; 104: 148-157. DOI:10.1016/j.jsat.2019.07.005.

Alter A, Yeager C, Analyst O: COVID-19 Impact on US National Overdose Crisis. Available at: http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf. Accessed March 17, 2021.

Davis MP, Pasternak G, Behm B: Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option. Drugs. 2018; 78(12): 1211-1228. DOI:10.1007/s40265-018-0953-z.

Stein C, Machelska H: Modulation of peripheral sensory neurons by the immune system: Implications for pain therapy. Pharmacol Rev. 2011; 63(4): 860-881. DOI:10.1124/pr.110.003145.

Ahmadi J, Jahromi MS, Ehsaei Z: The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: A randomized, double-blind, clinical trial. Trials. 2018; 19(1): 462. DOI:10.1186/s13063-018-2843-9.

Raffa RB, Haidery M, Huang H-M, et al.: The clinical analgesic efficacy of buprenorphine. J Clin Pharm Ther. 2014; 39(6): 577-583. DOI:10.1111/jcpt.12196.

Meske DS, Lawal OD, Elder H, et al.: Efficacy of opioids versus placebo in chronic pain: A systematic review and metaanalysis of enriched enrollment randomized withdrawal trials. J Pain Res. 2018; 11: 923-934. DOI:10.2147/JPR.S160255.

Koppert W, Ihmsen H, Körber N, et al.: Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model. Pain. 2005; 118(1-2): 15-22. DOI:10.1016/j.pain.2005.06.030.

Silverman SM: Opioid induced hyperalgesia: Clinical implications for the pain practitioner. Pain Physician. 2009; 12(3): 679-684.

Webster L, Gudin J, Raffa RB, et al.: Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. Pain Med. 2020; 21(4): 714-723. DOI:10.1093/pm/pnz356.

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. DOI:10.1002/14651858.CD002207.pub4.

Evans E, Li L, Min J, et al.: Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10. Addict. 2015; 110(6): 996-1005. DOI: 10.1111/add.12863.

Substance Abuse and Mental Health Services Administration: Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2020.

Lee JD, Nunes EV, Novo P, et al.: Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicentre, open-label, randomised controlled trial. Lancet. 2018; 391(10118): 309-318. DOI:10.1016/S0140-6736(17)32812-X.

Park TW, Larochelle MR, Saitz R, et al.: Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine. Addict. 2020; 115(5): 924-932. DOI:10.1111/ add.14886.

Aiyer R, Gulati A, Gungor S, et al.: Treatment of Chronic Pain With Various Buprenorphine Formulations: A Systematic Review of Clinical Studies. Anesth Analg. 2018; 127(2): 529-538. DOI:10.1213/ANE.0000000000002718.

Cote J, Montgomery L: Sublingual buprenorphine as an analgesic in chronic pain: A systematic review. Pain Med. 2014; 15(7): 1171-1178. DOI:10.1111/pme.12386.




How to Cite

Potru, DO, FASAM, S., M. Sprintz, DO, DFASAM, A. M. Barreveld, MD, and L. Kohan, MD. “Buprenorphine: Not a Silver Bullet, and Still Controversial”. Journal of Opioid Management, vol. 17, no. 7, Aug. 2021, pp. 9-10, doi:10.5055/jom.2021.0618.