Pain Physician. 2012 Jul;15(3 Suppl):ES59-66.

Conversion of chronic pain patients from full-opioid agonists to sublingual buprenorphine.

Daitch J, Frey ME, Silver D, Mitnick C, Daitch D, Pergolizzi J.

Source

Advanced Pain Management and Spine Specialists, Fort Myers, FL.

PMID: 22786462
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Retrospective data from 104 patients poorly controlled chronic pain electing to switch from other opiate medications to high dose sublingual buprenorphine.   The mean daily preinduction morphine equivalent dose of opioid was 180 mg.

They appear to have been transitioned easily in an out patient setting

Buprenorphine SL was administered to patients after they had discontinued all opioid medications at least 24 hours prior (48-72 hours for methadone). Initially, 8 mg of buprenorphine SL was given sublingually. Patients were instructed to dissolve an additional dose of 8 mg one hour later if pain or withdrawal symptoms continued. Patients were instructed not to exceed 32 mg of buprenorphine SL daily.

On a 0-10 scale, pain scores decreased by 2.3 on average. The decrease was less for those who had been on higher morphine equivalents, but patients taking > 400mg morphine equivalent still reported the on average a 1.1 point decrease. 



Once patients were converted to buprenorphine and established an effective dose, no escalation in medication use was noted. Patients did not overuse medication and rarely ran out 
early.



Patients were disqualified for the study if they were not on buprenorphine SL for at least 
60 days, were taking buprenorphine SL before the first clinic visit, were noncompliant in the treatment plan, or continued to use opioid medications.  This may have eliminated some patients who did not do well from the final reported success.