{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:53:14Z","timestamp":1785541994975,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Minority Health and Health Disparities of the National Institute of Health","award":["U54MD007605"],"award-info":[{"award-number":["U54MD007605"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Buprenorphine is a semi-synthetic long-acting partial \u00b5-opioid receptor (MOR) agonist that can be used for chronic pain as a sublingual tablet, transdermal patch (Butrans\u00ae), or a buccal film (Belbuca\u00ae). Buprenorphine\u2019s unique high receptor binding affinity and slow dissociation at the MOR allow for effective analgesia while offering less adverse effects compared to a full agonist opioid, in particular, less concern for respiratory depression and constipation. It is underused in chronic pain and palliative care due to misconceptions and stigma from its use in opioid use disorder (OUD). This case report discusses the unique pharmacology of buprenorphine, including its advantages, disadvantages, available formulations, drug\u2013drug interactions, initiation and conversion strategies, and identifies ideal populations for use, especially within the palliative care patient population.<\/jats:p>","DOI":"10.3390\/pharmacy12030078","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T10:26:36Z","timestamp":1715682396000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Buprenorphine Use for Analgesia in Palliative Care"],"prefix":"10.3390","volume":"12","author":[{"given":"Leanne K.","family":"Jackson","sequence":"first","affiliation":[{"name":"Rehabilitation & Extended Care Line, Section of Palliative Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA"},{"name":"Division of Geriatric and Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-2297","authenticated-orcid":false,"given":"Ivy O.","family":"Poon","sequence":"additional","affiliation":[{"name":"Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA"},{"name":"Clinical Pharmacy Specialist\/Pain & Palliative Care, Houston Methodist Hospital, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6627-2697","authenticated-orcid":false,"given":"Mary A.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Rehabilitation & Extended Care Line, Section of Palliative Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA"},{"name":"Division of Geriatric and Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Imam","sequence":"additional","affiliation":[{"name":"Rehabilitation & Extended Care Line, Section of Palliative Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA"},{"name":"Division of Geriatric and Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula K.","family":"Braun","sequence":"additional","affiliation":[{"name":"Rehabilitation & Extended Care Line, Section of Palliative Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA"},{"name":"Division of Geriatric and Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,13]]},"reference":[{"key":"ref_1","unstructured":"United States Drug Enforcement Administration (2023, August 25). Drug Scheduling, Available online: https:\/\/www.dea.gov\/drug-scheduling."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"37517","DOI":"10.52965\/001c.37517","article-title":"Buprenorphine and its formulations: A comprehensive review","volume":"10","author":"Poliwoda","year":"2022","journal-title":"Health Psychol. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1007\/s11864-021-00910-8","article-title":"Treating Chronic Pain with Buprenorphine\u2014The Practical Guide","volume":"22","author":"Case","year":"2021","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_4","unstructured":"US Department of Health and Human Services (2023, September 11). Pain Management Best Practices Inter-Agency Task Force Report, Available online: https:\/\/www.hhs.gov\/sites\/default\/files\/pain-mgmt-best-practices-draft-final-report-05062019.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1136\/spcare-2022-003954","article-title":"Buprenorphine","volume":"13","author":"Davis","year":"2023","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1080\/03602532.2016.1192642","article-title":"Metabolomics of methadone: Clinical and forensic toxicological implications and variability of dose response","volume":"48","year":"2016","journal-title":"Drug Metab. Rev."},{"key":"ref_7","unstructured":"(2023, September 11). Drugs|AccessPharmacy|McGraw Hill Medical. Available online: https:\/\/accesspharmacy-mhmedical-com.tsu.idm.oclc.org\/drugs.aspx?gbosID=426498#monoNumber=426498&sectionID=241825556&tab=tab0."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/pm\/pnz356","article-title":"Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion","volume":"21","author":"Webster","year":"2020","journal-title":"Pain Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00406-019-01091-0","article-title":"Buprenorphine-cannabis interaction in patients undergoing opioid maintenance therapy","volume":"271","author":"Vierke","year":"2021","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1001\/jama.2022.17485","article-title":"Association between Sublingual Buprenorphine-Naloxone Exposure and Dental Disease","volume":"328","author":"Etminan","year":"2022","journal-title":"JAMA"},{"key":"ref_11","unstructured":"(2023, September 11). BELBUCA\u00ae (Buprenorphine Buccal Film)|Get Back to Life. Available online: https:\/\/www.belbuca.com\/."},{"key":"ref_12","unstructured":"(2023, September 11). Butrans\u00ae (Buprenorphine) Transdermal System CIII|Official HCP Site. Available online: https:\/\/butrans.com\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1007\/s11095-023-03487-z","article-title":"In Vitro-In Vivo Correlation of Buprenorphine Transdermal Systems Under Normal and Elevated Skin Temperature","volume":"40","author":"Thomas","year":"2023","journal-title":"Pharm. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/j.addr.2007.07.004","article-title":"Transdermal skin delivery: Predictions for humans from in vivo, ex vivo and animal models","volume":"59","author":"Godin","year":"2007","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/cpdd.934","article-title":"Evaluation of Drug-Drug Interaction Liability for Buprenorphine Extended-Release Monthly Injection Administered by Subcutaneous Route","volume":"10","author":"Kharidia","year":"2021","journal-title":"Clin. Pharmacol. Drug Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.drugalcdep.2012.08.002","article-title":"Buprenorphine\/Naloxone and Methadone Effects on Laboratory Indices of Liver Health: A Randomized Trial","volume":"128","author":"Saxon","year":"2013","journal-title":"Drug Alcohol Depend."},{"key":"ref_17","unstructured":"Horn, J.R., and Hansten, P.D. (2015). Drug Interactions with CYP3A4: An Update, American College of Clinical Pharmacy. Available online: https:\/\/www.pharmacytimes.com\/view\/drug-interactions-with-cyp3a4-an-update."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC Clinical Practice Guideline for Prescribing Opioids for Pain\u2014United States, 2022","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm. Rep."},{"key":"ref_19","unstructured":"American Society of Addiction Medicine (ASAM) (2023, November 08). Public Policy Statement on Morphine Equivalent Units\/Morphine Milligram Equivalents. Available online: https:\/\/www.asam.org\/docs\/default-source\/public-policy-statements\/2016-statement-on-morphine-equivalent-units-morphine-milligram-equivalents.pdf."},{"key":"ref_20","unstructured":"(2020, August 25). Health and Human Services, Available online: https:\/\/www.hhs.gov\/guidance\/document\/opioid-oral-morphine-milligram-equivalent-mme-conversion-factors-0."},{"key":"ref_21","unstructured":"(2024, April 12). Pain in Patients with Cancer, or Those at Advanced Stages of COPD of Heart Failure\u2014Richtlijnen Palliatieve Zorg (Palliaweb.nl). Available online: https:\/\/palliaweb.nl\/richtlijnen-palliatieve-zorg\/guidelines\/pain-in-patients-with-cancer,-or-those-at-advanced."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1089\/jpm.2021.0378","article-title":"Buprenorphine microdosing for the Pain and Palliative Care Clinician","volume":"25","author":"Quirk","year":"2002","journal-title":"J. Palliat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Preux, C., Bertin, M., Tarto, A., Authier, N., Pinol, N., Brugnon, D., Pereira, B., and Guastella, V. (2002). Prevalence of Opioid Use Disorder among Patients with Cancer-Related Pain: A Systemic Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11061594"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"542","DOI":"10.21037\/apm.2019.12.09","article-title":"Combining opioids and benzodiazepines: Effect on mortality and severe adverse respiratory events","volume":"9","author":"Boon","year":"2020","journal-title":"Ann. Palliat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1533-2500.2008.00204.x","article-title":"Opioids and the management of chronic severe pain in the elderly: Consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone)","volume":"8","author":"Pergolizzi","year":"2008","journal-title":"Pain Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1111\/bph.13750","article-title":"Opioids and the immune system\u2014Friend or foe","volume":"175","author":"Plein","year":"2018","journal-title":"Br. J. Pharmacol."},{"key":"ref_27","unstructured":"(2023, September 04). Available online: https:\/\/www.samhsa.gov\/medications-substance-use-disorders\/waiver-elimination-mat-act."},{"key":"ref_28","first-page":"100154","article-title":"A content review of buprenorphine training programs for pharmacists","volume":"6","author":"Davis","year":"2022","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.japh.2023.06.001","article-title":"Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act","volume":"63","author":"Adams","year":"2023","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_30","first-page":"30","article-title":"Removal of DEA requirement makes pharmacists part of solution for treating opioid use disorder","volume":"29","author":"Bonner","year":"2023","journal-title":"PharmacyToday Pract. 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