Evaluation of Flexible Buprenorphine Dosing in Patients with Chronic Pain

Buprenorphine is a mixed agonist-antagonist, safer for long-term use compared to full agonist opioids. There is no literature to describe utilization of flexible buprenorphine dosing regimens in the chronic pain population. This was a retrospective single center, observational study. Inclusion criteria were age 18 and older, diagnosis of chronic pain, and prescribed buprenorphine. Patients with a diagnosis of opioid use disorder (OUD) were excluded. Buprenorphine regimens analyzed included: scheduled buprenorphine, scheduled plus as needed (PRN) buprenorphine, PRN buprenorphine alone, and scheduled buprenorphine plus PRN full µ-opioid agonist. The primary outcome was the percent of patients on each buprenorphine regimen. The secondary outcome was duration of buprenorphine therapy. Overall, 691 patients were reviewed, with 401 meeting inclusion criteria. Scheduled buprenorphine was prescribed to 340 patients (84.4%), while 37 patients (9.2%) were prescribed scheduled plus PRN buprenorphine. Patients exposed to flexible dosing remained on treatment longer than those on scheduled buprenorphine alone (HR 3.50, CI 2.07-5.92, NNT 9.0). Flexible buprenorphine dosing was utilized for chronic pain. Patients on scheduled plus PRN buprenorphine were on treatment longer than those on scheduled buprenorphine alone. Scheduled plus PRN buprenorphine can be considered for patients with chronic pain.