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
More than 50 million Americans suffer from chronic pain and in 2017, there were 58 opioid prescriptions written per every 100 Americans.^1,2 Buprenorphine is indicated for both pain management and opioid use disorder (OUD) and mechanistic reasoning suggests a lower potential for misuse. However, there is no guideline-based recommendation for buprenorphine’s place in therapy and the evidence for its use differs by population and formulation. Buprenorphine is a partial mu-agonist and kappa-antagonist with a long half-life and high protein binding affinity. This results in reduced opioid dependence, prolonged analgesia, and low potential for withdrawal.^4-6 Buprenorphine is co-formulated with naloxone, an opioid antagonist, to reduce its abuse potential. Buprenorphine/naloxone prescribing is limited due to the requirement of prescribers to hold DEA X Waivers as it is approved only for OUD while single agent buprenorphine branded transdermal patches and buccal film do not have these requirements.

In addition to the prescribing limitations and cost of branded products, the evidence for buprenorphine’s use in pain management has limitations. Multiple systematic reviews have evaluated buprenorphine’s role in chronic pain management, but results have been variable regarding analgesic efficacy, functional outcomes data is limited. Further, studies were plagued with high drop-out rates and lacked head-to-head trials with active control. Transdermal buprenorphine is an effective analgesic in patients with chronic pain when compared to placebo (74.5% vs. 50% (P=0.0003) OR=3).⁷ Buccal data also shows a significant decrease in pain scale ratings compared to placebo (mean difference −0.67 p=0.0012), but still increase pain levels from baseline.⁸ Sublingual buprenorphine/naloxone provides better (pain reduction 66-86%) for patients who are already opioid dependent or those who struggle with substance dependence.⁹ However, information directly comparing abuse potential is not available. During this presentation we will explore the differences in evidence supporting buprenorphine’s role in chronic pain management in patients with and without opioid dependence and provide graded recommendations for use by population and formulation.

Educational Objectives:

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

• List 3 barriers to buprenorpine's role in chronic noncancer pain management.
• Explain the strength of recommendation and differentiate gaps within supporting evidence for buprenorphine use between two different patient populations.
• Given a scenario, identify at least one population in which buprenorphine therapy would be appropriate.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The assigned universal program number(s) is JA4008223-0000-23-083-H08-P. .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit

Suggested Additional Reading & Joint Accreditation Statement: This statement supersedes any other statement on this page::

Suggested Additional Reading

1. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
2. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2pdf icon. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
3. Jackman RP, Purvis JM, Mallett BS. Chronic nonmalignant pain in primary care. Am Fam Physician. 2008 Nov 15;78(10):1155-62. PMID: 19035063.
4. Kamei J, Saitoh A, Suzuki T, Misawa M, Nagase H, Kasuya Y. Buprenorphine exerts its antinociceptive activity via mu 1-opioid receptors. Life Sci. 1995;56:PL285–PL290.
5. Koppert W, Ihmsen H, Körber N, et al. Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model. Pain. 2005;118:15–22.
6. Lutfy K, Eitan S, Bryant CD, et al. Buprenorphine-induced antinociception is mediated by mu-opioid receptors and compromised by concomitant activation of opioid receptor-like receptors. J Neurosci. 2003;23:10331–10337.
7. Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Anesthesiology. 2014;120:1262–1274
8. Poulain P, Denier W, Douma J, et al. Efficacy and safety of transdermal buprenorphine: a randomized, placebo-controlled trial in 289 patients with severe cancer pain. J Pain Symptom Manage.2008;36:117–125.
9. Rauck RL, Potts J, Xiang Q, Tzanis E, Finn A. Efficacy and tolerability of buccal buprenorphine in opioid-naive patients with moderate to severe chronic low back pain. Postgrad Med. 2016;128:1–11.

Joint Accreditation Statement

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.