Buprenorphine may reduce opioid use for sickle cell disease patients
Study: Microdosing via telemedicine possible alternative to in-person induction
Adults with sickle cell disease (SCD) who are started on buprenorphine to ease chronic pain — either in a clinical setting or at home via telemedicine — may be able to reduce their use of opioids and visit the hospital less frequently, a small study suggests.
Buprenorphine induction — the process of carefully starting buprenorphine treatment during early opioid withdrawal to control symptoms and avoid side effects — typically follows a traditional approach in the clinical setting, where the medication is given after withdrawal symptoms have begun. At home, however, it’s often started with a microdose — a very small amount — that is gradually increased over several days.
“Microdosing of buprenorphine via telemedicine is a feasible alternative to in-person inductions if there are concerns of space constraints in the clinical setting, and should be considered a treatment option for selected patients,” researchers wrote.
The study, “Buprenorphine Is Associated With Lower Home Opioid Use and Acute Care Utilization in Sickle Cell Disease,” was published in the journal Pain Management Nursing.
Buprenorphine approved to treat opioid use disorder
In SCD, abnormally shaped red blood cells block blood vessels and compromise how much oxygen gets delivered to the body’s tissues. This can cause sudden episodes of severe pain, called vaso-occlusive crises, which require strong analgesics such as opioids.
How opioids are used in SCD depends on the type and severity of pain a patient is experiencing, but they are usually prescribed only when other medications fail to ease pain. Because opioids are highly addictive and carry serious risks, there is growing concern about their misuse and overuse.
Buprenorphine is a medication approved to treat opioid use disorder, which is marked by the compulsive use of opioids at higher doses or for longer periods than intended. Buprenorphine is sometimes used off-label in SCD. It works by partially activating opioid receptors in the brain, which helps ease pain, but with a lower risk of addiction and side effects compared with full opioids.
Emergency room visits decreased, on average, after treatment
To understand how well buprenorphine works for adults with SCD who experience long-lasting pain, researchers at the Mount Sinai Center for Sickle Cell Disease in New York reviewed the medical records of 13 patients (eight women and five men) who began the treatment at an average age of 28.1 years old. Two patients had opioid use disorder.
Patients started buprenorphine at an average daily dose of 12.3 mg and stayed on treatment for an average of 235 days (nearly eight months). Eight patients started treatment in the hospital after a vaso-occlusive crisis, and six began treatment at home, with doctors sending instructions by telephone or text messages. In one case, induction in the hospital did not work due to sudden withdrawal, so that patient was excluded.
On average, patients visited the emergency room less frequently after treatment than before treatment (5.9 vs. 7.2 visits per patient-year). Patient-years account for both the number of patients studied and the length of time each was observed. One patient-year could mean one patient studied for one year.
Buprenorphine could be an alternative to decreasing home opioid use.
Buprenorphine-treated patients had less hospital admissions (5.6 vs. 8.5 admissions per patient-year) and fewer visits to treatment centers (2.2 vs. 3 visits per patient-year). Daily use of opioids at home also decreased from an average of 189.3 morphine milligram equivalents to 35.6 morphine milligram equivalents, a measure of the cumulative daily dose of opioids.
Both patients with opioid use disorder had long-lasting pain due to SCD. One reduced the number of acute care visits from 20 to 3 after starting buprenorphine and stopped using full opioids. The other had 41 visits before buprenorphine induction and 19 after, and reduced their dose of opioids by nearly half.
Buprenorphine induction via telemedicine using microdosing “is a relatively novel approach to pain management,” the researchers wrote. Despite the small number of patients in this study, the use of this approach was “successful,” they noted.
“In the context of the existing literature, this study adds that buprenorphine may be suitable for individuals with SCD with and without [opioid use disorder],” the researchers concluded, noting that “buprenorphine could be an alternative to decreasing home opioid use.”
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