From the Guidelines
Administering opioids to a patient on Suboxone (buprenorphine/naloxone) is generally not recommended and can be dangerous due to the high binding affinity of buprenorphine for opioid receptors, which can block the effects of other opioids and increase the risk of respiratory depression and overdose. According to the most recent and highest quality study, 1, buprenorphine has a high affinity for the μ-opioid receptor, which can diminish the ability of other full agonist opioids to dislodge it from the receptor. This blocking of other full opioid agonists is a beneficial property in the treatment of opioid use disorder, but it can also pose a challenge in achieving analgesia during acute episodes of pain.
Some key points to consider when managing pain in patients on Suboxone include:
- Buprenorphine can provide analgesia over a long period of time due to its high affinity and slow dissociation from the μ-opioid receptor 1
- The dose of buprenorphine can be increased to provide additional analgesia, but this may also increase the risk of side effects such as headache and constipation 1
- In emergency situations requiring acute pain management, specialized approaches may be needed, such as temporarily discontinuing Suboxone, using higher doses of short-acting opioids with careful monitoring, or employing non-opioid pain management strategies 1
- Any changes to a patient's Suboxone treatment should only be made by healthcare providers experienced in addiction medicine, as disrupting maintenance therapy can risk relapse 1
In terms of specific management strategies, the study by 1 suggests that the prescribed daily dose of buprenorphine, indication for buprenorphine treatment, risk of relapse, and expected level of postsurgical pain should be reflected in a patient-centered final decision to continue or hold buprenorphine. Additionally, the study notes that concomitant use of buprenorphine and QT-prolonging agents is contraindicated, and that multiple drug-drug interactions resulting in QT-interval prolongation, serotonin syndrome, paralytic ileus, reduced analgesic effect, or precipitation of withdrawal symptoms are possible.
From the Research
Opioid Administration to Suboxone Patients
- The administration of opioids to patients on Suboxone is a complex issue, with various factors to consider, including the patient's medical history, current medication regimen, and potential risks of opioid misuse or addiction 2, 3.
- Suboxone, which contains buprenorphine, is a partial opioid agonist that can displace full agonists from the μ-opioid receptor, potentially leading to withdrawal symptoms if not managed properly 4.
- Studies have explored the use of buprenorphine for pain management, including its initiation strategies, and have found that it can be an effective option for patients with opioid use disorder (OUD) and/or chronic pain 4, 5.
- However, the use of opioids, including buprenorphine, requires careful monitoring and adherence to prescribing guidelines to minimize the risk of misuse, addiction, and overdose mortality 2, 3, 6.
- The decision to administer opioids to a Suboxone patient should be made on a case-by-case basis, taking into account the patient's individual needs and circumstances, and with careful consideration of the potential benefits and risks 4, 5.