Bup or bust! Expanding safe and effective use of buprenorphine in the adolescent population

Key Message: Buprenorphine is increasingly used in adult palliative care due to its safety and efficacy in managing pain, however use in pediatrics remains limited. In collaboration with buprenorphine experts and pediatric palliative care experts, we will discuss expanding safe and effective buprenorphine use for adolescents.

Abstract:

Background: Adolescents living with chronic and/or life threatening, life limiting disease are a unique and vulnerable population. Disruption in normal life trajectories may lead to feelings of loss of control and prospects of a “normal life” may feel uncertain. As providers working with adolescent patients faced with disease related pain, these factors may lead to distinct challenges in pain management, particularly if the patient engages in risky behaviors, such as self-adjusting medications. Buprenorphine, a medication historically restricted by the X-Waiver for treatment of substance use disorder, is effective for treating disease related pain. Less frequently utilized in pediatric palliative care, buprenorphine should be considered as an alternative to methadone and other full mu-agonist opioids in this population of patients to effectively manage young person’s pain.
Approach: Utilizing a case-based approach, this presentation will review challenges that palliative care providers may face when caring for adolescent patients with pain, pharmacology of buprenorphine and reasons buprenorphine should be considered for pain management by pediatric palliative care clinicians and those who care for adolescent patients. We will also discuss potential barriers to adoption and how to overcome them.
Implications: This session will be of interest to pediatric and adult palliative care providers who care for adolescents with complex disease related pain. It will provide expert guidance in the pharmacologic management of buprenorphine and how to navigate titration and treatment with short acting opioids when necessary.

References: Quirk K, Wright J, Marks A, Smith MA. Sublingual Buprenorphine for Pediatric Cancer Pain: A Case Report and Review of the Literature. J Pain Symptom Manage. 2020 Nov;60(5):1055-1058. doi: 10.1016/j.jpainsymman.2020.07.029. Epub 2020 Jul 30. PMID: 32739561.

Miller JC, Brooks MA, Wurzel KE, Cox EJ, Wurzel JF 3rd. A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder. Drugs R D. 2023 Dec;23(4):339-362. doi: 10.1007/s40268-023-00443-5. Epub 2023 Nov 8. PMID: 37938531; PMCID: PMC10676346.

Irwin, M., Gunther, W., Keefer, P., Saul, D., Singh, S. A., Wright, J., & Smith, M. A. (2021). Buprenorphine for Chronic Pain in a Pediatric Patient With Sickle-Cell Disease. Journal of Pain and Symptom Management, 62(5), 1086–1091. https://doi.org/10.1016/j.jpainsymman.2021.04.007