Outpatient Cross-Titration to Buprenorphine for Chronic Pain

Abstract

Background: Various protocols for micro-induction of buprenorphine in patients with opioid use disorder have been published. There is a paucity of literature similarly describing microinduction in patients converting from full agonist opioids to buprenorphine for chronic pain. As the prescription opioid epidemic continues to be problematic and more patients are being converted to buprenorphine, we are working to provide more guidance on goal dosages of buprenorphine and how to safely cross-titrate to that goal.

Purpose/hypothesis: As the prescription opioid epidemic continues to be problematic and more patients are being converted to buprenorphine, we are working to provide more guidance on goal dosages of buprenorphine and how to safely cross-titrate to that goal.

Procedures/data/observations: Our cross-titration protocol resulted in roughly half (15/31) patients successfully converting to and continuing with buprenorphine at 4 weeks, with an average duration of induction of 29 days. Average end titration dose for patients on buprenorphine/naloxone SL films was 7.9 ± 5.7 mg/day. Patients previously taking >120 mg MEDD stabilized on 8-16 mg/day.

Conclusions/applications: Clinical responses were widely variable, and many required slower taper and higher end titration buprenorphine dose than anticipated. Future work is focused on determining which factors contribute to the variation and whether adjustment to the protocol is warranted.