Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Buprenorphine is a medication-assisted treatment (MAT) agent that has become more commonly prescribed in recent years for patients with opioid use disorder (OUD). Although efficacious in helping patients manage their substance use disorder, a challenge arises when acute pain management is warranted during elective or emergent surgeries. Should a patient’s maintenance buprenorphine be continued or discontinued? Due to buprenorphine’s unique pharmacology and lack of evidence regarding how to approach acute pain management for these patients, recommendations are often based on expert opinion and case reports. This leaves clinicians puzzled on how to provide optimal care to patients on buprenorphine during care transitions.
This presentation aims to explore the clinical conundrum as to whether buprenorphine should be continued or discontinued during acute pain management scenarios.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Recognize appropriate action when presented with a patient who is on buprenorphine for OUD and presenting to the hospital.
• Review literature that assessment safety and efficacy of continuing vs. discontinuing bupronorphine in the setting of acute pain management
• Decide appropriate acute pain management for patients on buprenorphine given a set of patient specific factors

• Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is JA4008223-0000-23-067-H01-P. This module is a webcast of an ACPE approved live presentation. The minimum credit awarded for this module (1 contact hour) is determined by the length of the entire live presentation inclusive of the post-test.

  
  

Suggested Additional Reading:

1. Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. 2017 Jun;126(6):1180-1186.
2. Book SW, Myrick H, Malcolm R, Strain EC. Buprenorphine for postoperative pain following general surgery in a buprenorphine-maintained patient. Am J Psychiatry. 2007 Jun;164(6):979.
3. Bryson EO. The perioperative management of patients maintained on medications used to manage opioid addiction. Curr Opin Anaesthesiol. 2014 Jun;27(3):359-64.
4. Childers JW, Arnold RM. Treatment of pain in patients taking buprenorphine for opioid addiction #221. J Palliat Med. 2012 May;15(5):613-4.
5. Hansen LE, Stone GL, Matson CA, Tybor DJ, Pevear ME, Smith EL. Total Joint Arthroplasty in Patients Taking Methadone or Buprenorphine/Naloxone Preoperatively for Prior Heroin Addiction: A Prospective Matched Cohort Study. J Arthroplasty. 2016 Aug;31(8):1698-701
6. Jonan AB, Kaye AD, Urman RD. Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures. Pain Physician. 2018 Jan;21(1): E1-E12.
7. Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. J Addict Med. 2015 Sep-Oct;9(5):358-67.
8. Khelemsky Y, Schauer J, Loo N. Effect of buprenorphine on total intravenous anesthetic requirements during spine surgery. Pain Physician. 2015 Mar-Apr;18(2):E261-4.
9. Macintyre PE, Russell RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care. 2013 Mar;41(2): 222-30.
10. Rodgman C, Pletsch G. Double successful buprenorphine/naloxone induction to facilitate cardiac transplantation in an iatrogenically opiate-dependent patient. J Addict Med. 2012 Jun;6(2):177-8.
11. Sen S, Arulkumar S, Cornett EM, Gayle JA, Flower RR, Fox CJ, Kaye AD. New Pain Management Options for the Surgical Patient on Methadone and Buprenorphine. Curr Pain Headache Rep. 2016 Mar;20(3):16.