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 has proven an effective medication for treating opioid use disorder (OUD). It has demonstrated to reduce illicit opioid use, improve treatment retention for OUD, reduce the transmission of HIV, and reduce mortality related to opioid use. As a partial agonist at the mu-opioid receptor, buprenorphine has low intrinsic activity, yet high affinity. This generates a safety profile by establishing a ceiling effect of buprenorphine in which the maximum effect on the opioid receptors is achieved at 16 mg. This ceiling effect limits euphoria and respiratory depression but may not relieve opioid cravings. Despite this, a maximum recommended dose of 16 mg is utilized by most health care providers. Clinical trials do not compare craving scores or symptom relief at higher doses. This generates the question if there is any efficacy for high-dose buprenorphine dosing in the setting of continued cravings at doses above 16 mg. Pharmacology data identifies that 80-95% of mu-opioid receptors are occupied at a dose of 16 mg. After conducting a literature review, two strategies for high-dose buprenorphine were identified, induction therapy and maintenance dosing. Of the limited literature available, high-dose buprenorphine induction appears to be safe and suppresses opioid cravings and withdrawal. However, the literature does not identify if high-dose buprenorphine induction improves outcomes such as mortality and treatment retention. Alternative day dosing is achieved based on buprenorphine’s long half-life. Compared to daily dosing, alternative day dosing is not superior, but not inferior in treatment retention and reducing illicit opioid use. High-dose buprenorphine given daily may improve treatment retention at doses of 30-32 mg. Based on the available data, high-dose buprenorphine induction may demonstrate improved acute opioid withdrawal treatment while high-dose maintenance therapy may improve treatment retention. Both dosing strategies require long-term data to support treatment retention.

Educational Objectives:

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

• Recognize standard buprenorphine dosing for the treatment of opioid use disorder.
• Describe the ceiling effect related to the pharmacokinetics of buprenorphine.
• Discuss the efficacy of high-dose buprenorphine dosing for the treatment of opioid use disorder.

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 JA4008223-0000-23-103-H08-P.  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit.

Joint Accreditation Statement - Note: This Accreditation Statement Supersedes All Other Statements:

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.

Pharmacy (CPE) - This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other Healthcare Professionals: 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.