An Evaluation of Buprenorphine Transition Strategies in a Pharmacist Led Chronic Pain Clinic

Buprenorphine offers comparable analgesia with a superior safety profile compared to full mu opioid agonists, particularly for high-risk populations. However, optimal transition strategies remain unclear, and limited data exists evaluating patient-specific factors which may influence success. This retrospective chart review evaluated 117 patients treated at a Veterans Affairs, pharmacist-led chronic pain management clinic who attempted to transition from long-term opioid therapy (LTOT) to buprenorphine. Two transition methods were assessed: stop/start and cross-titration. Overall, 55.56% of patients successfully transitioned from LTOT to buprenorphine. The stop/start method was associated with greater odds of successful transition compared with cross-titration (OR 4.63, p < 0.001). Adverse drug reactions were more common in the cross-titration group and independently associated with treatment failure (p = 0.006). Concomitant use of non-opioid analgesics was associated with improved outcomes (p = 0.031). These findings suggest that the stop/start method, used alongside non-opioid analgesics, may be associated with more successful transition outcomes and could help inform individualized care plans for patients transitioning from full mu agonists to buprenorphine for chronic pain.