Ask The Pharmacist: Buprenorphine’s Role in Workers’ Compensation Pain Management

What is the role of buprenorphine in pain management for workers’ compensation? 

Buprenorphine, a Schedule III controlled substance approved by the U.S. Food and Drug Administration (FDA), is increasingly being considered for pain management in workers' compensation cases. This partial opioid agonist offers a unique profile that balances effective pain relief with a lower risk of abuse and dependence compared to full opioid agonists.

Safety Profile and Risks

While buprenorphine has a more favorable safety profile than traditional opioids, it is not without risks. Potential side effects include cardiac concerns, respiratory depression, gastrointestinal issues and euphoria. Despite its partial agonist status, buprenorphine should still be considered an opioid with associated risks.

Dosage and Indications

Buprenorphine is available in various strengths for different indications. Lower strengths are typically used for treating opioid use disorder (OUD), while higher strengths are indicated for pain management. However, a concerning trend has emerged where lower-strength formulations are being prescribed off-label for chronic pain management.

Challenges in Risk Assessment

One complicating factor in the use of buprenorphine for pain management is that the Centers for Disease Control and Prevention (CDC) does not include it in its Morphine Milligram Equivalent (MME) table. This omission can lead to a false sense of security and potential patient safety risks, as it may not be properly evaluated for opioid risk when prescribed for pain.

Forms and Administration

Buprenorphine is available in several forms, including:

• Sublingual tablets or films
• Transdermal patches
• Injections (including extended-release formulations)
• Implants (for opioid dependence treatment—discontinued formulation)

These various formulations allow for flexibility in treatment plans, catering to different patient needs and pain management scenarios in workers' compensation cases.

Considerations for Workers' Compensation

When considering buprenorphine for pain management in workers' compensation cases, health care providers and claims managers should:

1. Carefully assess the appropriateness of buprenorphine based on the individual case and injury.
2. Be aware of the potential for off-label prescribing of lower-strength formulations.
3. Monitor patients closely for side effects and signs of dependence.
4. Consider the long-term implications of buprenorphine use in the context of return-to-work goals.
5. Stay informed about the latest guidelines and research on buprenorphine use in pain management.

Buprenorphine presents a potentially valuable tool for pain management in workers' compensation cases, offering effective pain relief with a lower risk profile than full opioid agonists. However, its use requires careful consideration, appropriate prescribing practices, and ongoing monitoring to ensure patient safety and optimal outcomes in the workers' compensation setting.

Available Buprenorphine Products

*Note, only three products are approved for severe pain, all others are for opioid use disorder/opioid dependence.

This information is meant to serve as a general overview, and any specific questions should be fully reviewed with a health care professional such as the prescribing doctor or dispensing pharmacist.

Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at AskThePharmacist@enlyte.com.

To read more Ask The Pharmacist articles, please visit enlyte.com/ask-the-pharmacist. 

References: 

https://cdc.gov 

https://riskandinsurance.com/7-current-and-evolving-drug-trends-in-workers-comp-medical-management/