b'Buprenorphine for Post-Surgical Pain OKfor Opioid-Use Disorder PatientsBuprenorphine can be an effective part of a treatment plan for opioid-use disorder, but a quandary sometimes occurs when anesthesia is necessary in a patient taking the drug chronically for OUD. A recent study using VA data advised, however, that buprenorphine can be safely continued in most patients with various sources of pain management irrespective of the initial diagnosis of chronic pain or OUD.By Mary Anne DunkinDURHAM,NCOpioid-usedisorder(OUD)hassuch as surgery, that requires anesthesia. On the one been referred to as a battle that takes more lives ev- handmodifyingbuprenorphineuseposestherisk ery year than the Vietnam or Korean wars.ofinadequatelymanagedpain.Discontinuingbu-According to the national Centers for Disease Controlprenorphine also has numerous implications, includ-andPrevention,opioidoverdoseskilledmorethaning risk of opioid-induced hyperalgesia that may re-80,000 people in 2021. While OUD can affect any- quire intensification of opioid therapy following sur-one, veterans have numerous risk factorsincludinggery. Additionally, patients may suffer from worsen-chronic pain, mental health conditions and trauma ing pain and withdrawal syndromes when other pain that place them at particular risk. Research indicatesregimens are substituted for nonopioid analgesics.thatveteransdiefromopioid-relatedoverdosesatWithminimalinformationtoguidethemthrough roughly twice the rate of the general population. thisdilemma,researchersturnedtoVAelectronic To combat this deadly disorder, many clinicians havehealth records to characterize what treatment modal-found it increasingly necessary to consider safe andity is being completed in practice and to determine if effective therapies to mitigate its risks for patients.it was safe and effective for patients, said Alexis C. One of these therapies is buprenorphine, a scheduleJones, PharmD, PGY-2 Ambulatory Care Pharmacy III, partial mu-opioid agonist that is FDA approvedResident at the Durham, NC, VA Health Care System.for moderate-to-severe acute and chronic pain.Theresearchersconductedaretrospectivecohort Asapartialagonistatthemu-opioidreceptor,studyusingdatacollectedfromelectronichealth buprenorphine offers potent analgesia while also pro- records from Jan. 1, 2012, to Jan. 1, 2022, said Jones. viding the benefit of a ceiling effect on respiratoryEligible patients included those who received an out-depression. Moreover, it interacts with other opioidpatient prescription for buprenorphine and presented receptors,suchasthedelta-opioidreceptor,kappatothe VAemergencydepartmentforthetreatment opioid receptor and opioid receptorlike1 , mitigatingof acute pain or presented for a surgical procedure adverse effects, influencing mood, benefiting diverseduring the time period. Patients were excluded if the pain conditions and decreasing the risk of tolerancebuprenorphine prescription was in the buccal or trans-and dependence. dermal formulation, prescription was written by a non-VA provider, or the veteran received a full agonist opi-Prescribing Dilemmaoid 30 days before the index date. After the patients While buprenorphine has shown to be an effectivewere identified, as much information that could be part of a treatment plan for opioid-use disorder, a di- pulled from the corporate data warehouse were pulled lemma arises when a person taking the drug chroni- into a database and the rest of the information needed cally for OUD undergoes an acutely painful event,was collected via chart review, she said.18'