Buprenorphine is widely used as a treatment for patients with opioid use disorders, but has also been shown to be an effective treatment for cancer and neuropathic pain, with unique pharmacologic properties that give it several advantages over traditional opioids. Buprenorphine is associated with less analgesic tolerance, and is less likely to cause respiratory depression and constipation than other opioids. Buprenorphine also does not cause immunosuppression, sphincter of Oddi dysfunction, or hypogonadism like traditional opioids.  It may be ideal to consider for elderly or frail patients, because it causes less cognitive dysfunction and sedation. In addition, patients are less likely to experience severe withdrawal symptoms and develop drug dependence on buprenorphine when compared with other opioids.

Because of these advantages, some have proposed that buprenorphine should be considered as a first line treatment for patients requiring an opioid medication. In this concurrent session, we will review the pharmacology, indications and concerns for monitoring when using buprenorphine. We will discuss the practical uses of buprenorphine in patients who are opioid-naïve and opioid-tolerant. We will present cases outlining equianalgesic conversions, differences between the transdermal patch, sublingual tab and buccal formulations, as well as use in special populations, including the elderly/frail and patients with renal or hepatic impairment. The teaching format will be a mixture of large group didactic and interactive case-based presentations.