Compass Opioid Stewardship 2026 Virtual Symposium-FREE NO CME-07-Buprenorphine 101-Rachael Duncan-Handouts

07-Buprenorphine 101-Rachael Duncan-Handouts

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The document is a slide deck from the Compass Opioid Stewardship 2026 Virtual Symposium, “Buprenorphine 101,” focused on practical prescribing and transitioning strategies for buprenorphine in pain management and opioid use disorder (OUD). It reviews FDA-approved buprenorphine products by indication: Belbuca (buccal film) and Butrans (transdermal patch) for pain, and Suboxone/Subutex (sublingual/buccal) plus long-acting injectables Sublocade and Brixadi for OUD. The slides highlight that MME conversions for buprenorphine can be misleading—especially for SL products often excluded from MME calculations.<br /><br />Key pharmacology points include buprenorphine’s high mu-opioid receptor affinity, slow dissociation, partial agonist activity, and a ceiling effect that limits euphoria and respiratory depression, creating a wider therapeutic window. However, if full agonist opioids are still present, buprenorphine can displace them and precipitate withdrawal. For pain, analgesia is shorter than craving suppression (about 6–8 hours vs ~24 hours), so split dosing 2–4 times daily is recommended.<br /><br />The presentation connects chronic pain and substance use as a bidirectional, reinforcing relationship and cites a meta-analysis suggesting ~10% of chronic opioid therapy patients have problematic dependence and/or OUD. It emphasizes improved retention when medication-assisted treatment is integrated into primary care.<br /><br />Induction guidance includes a first-visit checklist (labs, short buprenorphine prescription, naloxone, and non-opioid withdrawal medications) and use of withdrawal scales (e.g., SOWS/COWS). Two main induction approaches are compared: standard induction requiring abstinence and moderate withdrawal, and low-dose/micro-induction that overlaps tiny buprenorphine doses with ongoing full agonist use—particularly useful in fentanyl exposure, high tolerance, methadone transitions, or prior precipitated withdrawal.<br /><br />Case examples illustrate successful rotations from high-dose oxycodone and long-term methadone to buprenorphine, improving safety and function and reducing oversedation-related emergency visits. The takeaway is to match product and transition method to dose, tolerance, comorbidities, and withdrawal risk, and to consider buprenorphine for both pain and OUD.

Keywords

Buprenorphine prescribing

Opioid stewardship

Opioid use disorder (OUD) treatment

Chronic pain management

Buprenorphine induction protocols

Micro-induction (low-dose induction)

Precipitated withdrawal prevention

Belbuca and Butrans for pain

Suboxone/Subutex and long-acting injectables (Sublocade, Brixadi)

MME conversion limitations