Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist; Patient Priority at the Interface Between Medical Disciplines

Abstract

Buprenorphine is a partial-agonist opioid that is prescribed as a Medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor (OR) affinity and binding co-efficient; when buprenorphine is administered simultaneously with a mu-opioid receptor full agonist (FAO), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacological management that requires the use of FAO. When patients receiving buprenorphine-MAT have come for operative procedures there has been clinical variance in approach to their MAT management. Recognizing the risk management challenge from both analgesia and MAT perspectives, we convened a multi-disciplinary group of clinicians who treat MAT patients and completed a literature review with the goal of generating a guideline for appropriate management of these patients presenting for a broad spectrum of surgical procedures. Our conclusion is that continuous simultaneous administration of buprenorphine products with FAO is safe when accounting for dose and timing, including surgeries that historically produce moderate to severe pain, and may further provide a beneficial analgesic synergy, less FAO burden and reduce relapse risk to this group.