Trends in Outpatient Buprenorphine Prescribing for Chronic Pain: A Retrospective Analysis Over 18 Months.

Abstract

Background: Buprenorphine, a partial opioid agonist, has gained attention for its use in chronic pain management due to its lower risk of abuse and respiratory depression compared to traditional opioids. The utilization of buprenorphine for chronic pain has increased in recent years. This study aimed to analyze trends in buprenorphine prescribing for chronic pain in an outpatient setting over an 18-month period, excluding buprenorphine-naloxone combinations used for opioid use disorder and opioid dependence.

Methods: A retrospective chart review was conducted, examining outpatient buprenorphine and long-acting opioid prescriptions issued by three pain management physicians between January 1, 2023, and June 30, 2024. Prescription data were collected from electronic medical records (EMRs) and analyzed across three six-month intervals: January 1, 2023, to June 30, 2023; July 1, 2023, to December 31, 2023; and January 1, 2024, to June 30, 2024. Only unique buprenorphine prescriptions for chronic pain management were included, while buprenorphine-naloxone prescriptions for opioid use disorder were excluded. Long-acting opioids analyzed included extended release (ER) formulations including tramadol ER, morphine ER, hydrocodone ER, oxycodone ER, fentanyl, and methadone.

Results: Over the 18-month study period, a total of 61 unique buprenorphine prescriptions for chronic pain were issued by the three physicians. The number of prescriptions increased across each six-month period: 18 prescriptions were issued between January 1, 2023, and June 30, 2023; 20 prescriptions from July 1, 2023, to December 31, 2023; and 23 prescriptions from January 1, 2024, to June 30, 2024. This represents a 27.8% increase over the entire 18-month period. During the same timeframe, 117 long-acting opioid prescriptions (excluding buprenorphine) were issued in the first six-month period, 121 prescriptions in the second period, and 108 prescriptions in the third period. Buprenorphine prescriptions accounted for 13.3% of all long-acting opioid prescriptions in the first period (18 out of 135 total prescriptions), 14.2% in the second period (20 out of 141 total prescriptions), and 17.6% in the third period (23 out of 131 total prescriptions). Notably, while the absolute number of buprenorphine prescriptions increased steadily, its proportion relative to total long-acting opioid prescriptions also grew over time.

Conclusions: The findings demonstrate a steady increase in buprenorphine prescribing for chronic pain in the outpatient setting, while long-acting opioid prescriptions exhibited a slight decline in the later periods. The proportion of buprenorphine prescriptions relative to long-acting opioids increased over time, suggesting growing acceptance of buprenorphine as a safer alternative for chronic pain management. Further research is needed to explore the factors driving these prescribing patterns and the long-term clinical outcomes associated with buprenorphine use in chronic pain management.