ABSTRACT
Buprenorphine is approved by the Food and Drug Administration for the treatment of chronic pain in low-dose transdermal patch formulations and for the treatment of addiction in high-dose sublingual tablets and films. Clinicians often prescribe these high-dose preparations "off label" for pain management. In the workers' compensation setting, it is particularly important to consider factors such as a) if the injured person has, and is being treated for co-occurring addiction as well as pain; b) if alternative therapies, including opioid withdrawal, were considered prior to initiating buprenorphine treatment; and c) the anticipated duration of treatment. This article reviews buprenorphine's approved indications, formulations, pharmacology, clinical efficacy, and special considerations in the workers' compensation setting.
Subject(s)
Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Occupational Diseases/drug therapy , Occupational Health , Workers' Compensation , Administration, Sublingual , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/chemistry , Buprenorphine/administration & dosage , Buprenorphine/adverse effects , Buprenorphine/chemistry , Drug Administration Schedule , Drug Approval , Humans , Occupational Diseases/diagnosis , Occupational Diseases/etiology , Off-Label Use , Opioid-Related Disorders/etiology , Opioid-Related Disorders/prevention & control , Patient Selection , Risk Assessment , Risk Factors , TabletsABSTRACT
Physicians have embraced the concept of long-term opioid treatment for chronic noncancer pain (CNCP), as evidenced by increased prescribing. Many patients have benefited from more liberal opioid prescribing, but many have not, and prescription opioid abuse has risen significantly coincident with increased prescribing. Because of the potentially serious adverse effects of opioids, physicians must balance potential benefits against risks, especially in individuals at risk for opioid misuse, abuse, or dependence. This article reviews long-term, continuous opioid treatment of CNCP, current treatment guidelines, addiction risk stratification, opioid-induced hyperalgesia, and endocrine dysfunction.
Subject(s)
Analgesics, Opioid/therapeutic use , Opioid-Related Disorders/etiology , Opioid-Related Disorders/prevention & control , Pain/drug therapy , Analgesics, Opioid/administration & dosage , Drug Utilization , Humans , Opioid-Related Disorders/diagnosis , Pain/etiology , Risk AssessmentABSTRACT
Debilitating chronic nonmalignant pain is often managed using opioid medications. However, with increased use of this drug class comes concern about adverse effects on patients' endocrine function. In the present review, the authors discuss opioid-induced interference with the hypothalamic-pituitary-gonadal axis, effects on adrenal androgen production, and endocrine deficiency. In addition, the authors describe symptomology for opioid-induced endocrinopathy as well as diagnostic testing options. Treatment modalities for those afflicted with this condition are also described.
Subject(s)
Analgesics, Opioid/adverse effects , Endocrine System Diseases/chemically induced , Adrenal Glands/drug effects , Adrenal Glands/physiopathology , Dehydroepiandrosterone/metabolism , Dehydroepiandrosterone/pharmacology , Humans , Hypogonadism/physiopathology , Hypothalamo-Hypophyseal System/drug effects , Pain/drug therapy , Testosterone/administration & dosageABSTRACT
Buprenorphine became available for office-based treatment of opiate dependence in January 2003, at which time the Underwood-Memorial Hospital Family Practice Residency Program began offering buprenorphine treatment at its family practice center. This article describes the patient selection process, outcomes, and obstacles to treatment. Patients who had a pharmaceutical benefit were much more likely to remain in treatment than those who had to pay for the medication. The authors are not aware of other residency programs currently providing buprenorphine training, and postulate reasons why family physicians in the United States have not readily adopted the office-based opiate treatment model.
