Managing long-term high-dose prescription opioids in patients with non-cancer pain The potential role of sublingual buprenorphine

Abstract

Background Opioids are frequently used to manage chronic non-cancer pain despite the lack of evidence of benefit and clear evidence of opioid-related harms. Patients undergoing high-dose opioid therapy are at risk of multiple complications, such as opioid toxicity, including fatal overdose and opioid dependence. Objective This article provides an overview of the pharmacology of buprenorphine and reviews current evidence for the use of high-dose sublingual buprenorphinenaloxone in the pharmacological management of patients at high risk of complications from chronic opioid use. Discussion Buprenorphine-naloxone is well tolerated by patients with chronic pain, and has the potential to improve pain scores and affective symptoms. This is exemplified in a case study based on these authors' experience in an addiction medicine setting. As the rates of pharmaceutical opioid prescribing and related harms continue to increase in Australia, buprenorphine-naloxone is a viable option to manage high-risk chronic pain patients who are unable to reduce or cease their opioid use.