Development of a standardized protocol for buprenorphine induction in a chronic pain clinic.

Objective: Create a standardized protocol document on how to convert patients from full opioid agonist to buprenorphine. Providing patients with the best possible chance of a seamless conversion resulting in decreased risk of failure of therapy with buprenorphine.

Methods: A 10-question survey was distributed to better understand the different aspects the providers consider when converting a patient from full opioid agonist to buprenorphine. A medication use evaluation was completed utilizing a retrospective qualitative design to identify all patients who had a new prescription for any buprenorphine product from a chronic pain provider to establish patterns of current practice. This information, in conjunction with guidance from current literature and medication package inserts, was used to create a protocol for buprenorphine induction. Providers were educated on buprenorphine prior to guidance document implementation.

Results: A five-page guidance document on how to convert patients from full opioid agonist to buprenorphine was created for providers within the chronic pain clinic. The document includes recommendations on which patients are candidates for buprenorphine versus those who are not. The document also provides a three-step process to successfully perform a conversion including which buprenorphine product and induction technique to utilize. Definitions of each induction technique along with examples are provided within the document. Recommendation for converting between buprenorphine patch and films are also listed within the document.

Discussion: The five-page guidance document was successfully implemented in June 2024, supplying pain providers with all the knowledge necessary to convert patients comfortably, thus providing patients with the best possible chance of a seamless conversion and decreasing risk of failure of conversion to buprenorphine due to inadequate induction technique.