A new study has determined that buprenorphine, an opioid that is safer than high-dose full agonist opioid therapy, can be used in patients with sickle cell disease (SCD).

The study, published in the American Journal of Hematology, employed a transitioning protocol developed by the researchers in 36 patients to convert from chronic opioid therapy to buprenorphine while reducing adverse events.

“Due to its complex receptor pharmacology, [buprenorphine] can precipitate opioid withdrawal when co-administered with higher doses of opioid agonists,” the authors wrote.

Over the last 10 years, the research team has developed a reproducible outpatient process for converting patients from chronic opioid therapy to buprenorphine, which offers pain relief with a lower risk of tolerance, withdrawal, and overdose. They described the experience of patients transitioning to buprenorphine after having a poor response to chronic opioid therapy.

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The patients were seen weekly and were individually weaned off of chronic opioid therapy as needed to achieve a target preinduction dose of 90 mg of oral morphine equivalents, with the aim of reducing withdrawal symptoms. Buprenorphine was initiated sublingually, and the dose was individually adjusted to manage pain based on patient ratings and the Clinical Opioid Withdrawal Score.

The results were positive, with all of the patients experiencing only mild withdrawal symptoms at the end of the induction period. There were a few instances of postinduction withdrawal symptoms that required a buprenorphine dose increase, and just 8% of patients chose to discontinue buprenorphine on their own. Most importantly, acute care utilization by the entire patient cohort dropped by 72.5%.

The authors concluded that the buprenorphine induction strategy was relatively safe and effective and carried a low risk of adverse events, including withdrawal.

Reference

David MS, Jones J, Lauriello A, et al. Converting adults with sickle cell disease from full agonist opioids to buprenorphine: a reliable method with safety and early evidence of reduced acute care utilization. Am J Hematol. Published online August 26, 2022. doi:10.1002/ajh.26699

buprenorphine hematologists Pulmonologists