Real-World Experience With Initiating Buprenorphine in Opioid Tolerant Patients with Cancer Pain.

Abstract

Full-opioid agonists are commonly used for cancer-related pain but include risks such as constipation and respiratory depression. Buprenorphine, a partial opioid agonist, may offer a safer alternative, though concerns regarding withdrawal symptoms and efficacy remain. This study evaluates the real-world success of initiating buprenorphine in opioid tolerant patients for cancer-related pain management. Assess the success rate of initiating buprenorphine products in opioid tolerant patients with cancer-related pain and chronic pain with a history of cancer and evaluate associated clinical outcomes including pain control, withdrawal symptoms, and buprenorphine discontinuation. This retrospective, single-center study included adult patients with active or historical malignancy who initiated transdermal or buccal buprenorphine between January 2023 and June 2024. The primary outcome was a successful initiation at 30 days, defined as continued buprenorphine use, absence of withdrawal symptoms, and stable or improved pain scores. A total of 77 patients were screened with 48 meeting inclusion criteria. Successful initiations occurred in 34 patients (71%). For the entire cohort, mean pain scores decreased from 6.3 at baseline to 4.9 at day 30. Withdrawal symptoms were reported in 8% of patients. On day 30, 77% remained on buprenorphine, and two patients resumed full-opioid agonists. Most patients who continued buprenorphine (65%) remained on their initial dose. Buprenorphine appears to be a safe and effective alternative for managing cancer-related pain, with minimal withdrawal symptoms and stable or improved pain control. These findings support broader use of buprenorphine products in cancer-related pain management, though further prospective studies are needed.