Buprenorphine Is Associated With Lower Home Opioid Use and Acute Care Utilization in Sickle Cell Disease.
Charleen Jacobs-McFarlane, Angela Liu, Brittany McCrary and 6 others
PMID 40447476WHAT IT FOUND
In adults with sickle cell disease who started buprenorphine, ED visits, pain hospitalizations, infusion visits, and home opioid doses were lower after induction.
This small single-center before-and-after study does not prove buprenorphine caused the reductions.
Key findings
01Care use was lower after induction: ED visits per patient-year were 7.2 before and 5.9 after, pain hospitalizations were 8.5 before and 5.6 after, and infusion center visits were 3.0 before and 2.2 after.
02Home opioid dose was 189.3 morphine milligram equivalents daily before induction and 35.6 after induction.
03Six patients continued concurrent full agonist opioids at a lower dose after induction, and inpatient inductions also involved patient-controlled analgesia opioids, intravenous hypotonic saline, NSAIDs, and other adjuvant medications.
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center retrospective chart review, so it cannot show that buprenorphine caused the reductions. Only 13 patients had an attempted induction, and 1 failed induction and was excluded. Four patients were lost to follow-up, and only nine of 13 continued to follow at the sickle cell center. Induction location and method varied, including inpatient traditional inductions and home telemedicine Bernese inductions, which could affect outcomes. Patients also received other pain treatments, and six continued concurrent full agonist opioids at a lower dose, so the contribution of buprenorphine alone cannot be separated. All patients were high or super utilizers who had failed chronic opioid therapy, so the findings may not apply to patients with lower acute care use or no chronic opioid therapy failure. Statistical tests were not adjusted for multiple comparisons.
The easy way to misread this
Do not read these reductions as proof that buprenorphine alone caused them. The study was a small retrospective chart review, patients also received other pain treatments, and six continued full agonist opioids at a lower dose.