From the Guidelines
Belbuca is not commonly used in the emergency room (ER) setting. Belbuca is a brand name for buprenorphine buccal film, which is primarily prescribed for chronic pain management rather than acute pain situations typically encountered in the ER. Emergency departments generally rely on faster-acting pain medications that can be administered intravenously for immediate relief, such as morphine, hydromorphone (Dilaudid), or fentanyl. According to a study published in the Annals of Emergency Medicine 1, ED visits resulting in opioid prescriptions have stabilized and may have peaked, indicating a shift towards more cautious opioid prescribing in emergency settings.
The properties of buprenorphine, as discussed in the Clinical Infectious Diseases journal 1, make it more suitable for chronic pain management due to its high binding affinity for the μ-opioid receptor and its ability to provide analgesia over a long period. However, its slower onset of action and the need for careful titration and monitoring make it less ideal for acute pain management in the ER.
A study published in the British Journal of Anaesthesia 1 highlights the importance of considering the perioperative management of buprenorphine, emphasizing the need to continue perioperative buprenorphine therapy to avoid destabilizing patients with a history of opioid use disorder. This further supports the notion that buprenorphine, and by extension Belbuca, is not typically used for acute pain management in the ER but rather for chronic pain management and opioid use disorder treatment.
Key points to consider include:
- Belbuca's slower onset of action compared to intravenous pain medications
- The need for careful titration and monitoring of Belbuca
- The preference for medications with predictable, rapid effects in acute pain management
- The importance of considering the perioperative management of buprenorphine to avoid destabilizing patients with opioid use disorder.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Buprenorphine Use in the ER
- Buprenorphine is a medication used to treat opioid use disorder (OUD) and is sometimes used in the emergency room (ER) setting 2, 3.
- There are different formulations of buprenorphine, including sublingual and injectable forms, which can be used in various settings, including the ER 3, 4.
- Buprenorphine initiation strategies have been developed to help patients transition from opioids to buprenorphine, including microdosing and traditional initiation methods 5.
- Guidelines for managing OUD, opioid withdrawal, and opioid overdose prevention in hospitalized adults recommend the use of buprenorphine or methadone to treat OUD and opioid withdrawal, and multimodal nonopioid therapy for acute pain management 6.
Belbuca Specific Use
- Belbuca is a brand name for buprenorphine, which is used to treat moderate to severe chronic pain and OUD 3, 5.
- There is limited information available on the specific use of Belbuca in the ER setting, but buprenorphine is sometimes used in this setting to treat OUD and opioid withdrawal 2, 4.
- Buprenorphine, including Belbuca, can be used in the ER to initiate treatment for OUD, especially in patients who are experiencing opioid withdrawal or who are at risk of overdose 6.
ER Setting Considerations
- The ER setting can be challenging for managing OUD and opioid withdrawal, due to the need for rapid assessment and treatment, and the potential for patients to leave the hospital before treatment is complete 4, 6.
- Buprenorphine, including Belbuca, can be a useful medication in the ER setting due to its ability to reduce opioid withdrawal symptoms and cravings, and its potential to reduce the risk of overdose 3, 5.
- However, more research is needed to determine the best strategies for initiating buprenorphine treatment in the ER setting, especially for patients who are using fentanyl or who have pain 6.