Buprenorphine Products for the Treatment of Pain: Relative Risk of Abuse and Related Clinical Outcomes Compared to Full μ-Opioid Agonist Medications

INTRODUCTION: The objective of this study was to utilize real-world data from National Poison Data System (NPDS) to evaluate the relative risk of intentional use and subsequent outcomes following exposures to buprenorphine buccal film (BBF) compared to immediate-release (IR) and extended-release (ER) full agonist opioid (FAO) formulations, and buprenorphine transdermal patch (BTP). METHODS: A cross-sectional study design compared exposures that involved BBF to those that involved IR FAO, ER FAO, and BTP using real-world data from NPDS. Data included individuals age 18 years and older involved in exposures managed by US poison centers from 2020 to 2023. Descriptive statistics were used to summarize study groups, exposures, and outcomes. Relative risk was calculated for exposure reasons and clinical outcomes using BBF as reference group. RESULTS: Dataset included 276 BBF, 43,322 IR FAO, 2453 ER FAO, and 134 BTP exposures. Compared to BBF, significantly higher risks were found for both IR FAO and ER FAO for intentional abuse, intentional suspected suicide, significant medical outcome, hospital admission, and treated/evaluated and released level of care. CONCLUSION: Findings from this study suggest that, compared to FAO, exposures to BBF managed by US poison centers were less likely to involve intentional abuse or suspected suicide, have a decreased risk of resulting in a life-threatening effect or death, and have a lower likelihood of subsequent hospital admission and emergency department visits. Along with published guidelines and medication labels (including boxed warnings), relative risks of intentional exposures and associated clinical outcomes should be considered when determining opioid therapy for pain management.