Buprenorphine as First-Line Opioid for Pain in Palliative Care: When, How, and For Whom?

Key Message: Buprenorphine offers a safer alternative to traditional opioids for palliative care patients, particularly those with complex needs. This session equips clinicians with practical strategies to overcome systemic barriers to access and calls for collective advocacy to ensure equitable availability of this essential medication across diverse care settings.

Abstract:

Background: In this presentation, we advocate for the use of buprenorphine as a first-line opioid for pain among patients with serious illness for whom opioid therapy is considered. We present a series of cases in which buprenorphine, an opioid with a better safety profile than full agonist opioids (e.g., morphine, oxycodone), can be considered the preferred first-line opioid (1). In particular, we will focus on specific whole-person considerations (e.g. age, comorbidities, financial resources, and performance status) relevant to palliative care practice in which buprenorphine may be a better choice for patients in pain (2). Importantly, we highlight buprenorphine’s many barriers to access, principally the lack of insurance coverage for pain, despite national guidelines recommending its use for pain (3). We will share successful and practical idiographic strategies for clinicians to advocate for their patients to gain access to buprenorphine (2). This session aims to provide practical tips for clinicians to navigate buprenorphine’s many barriers to access, as well as serve as a call for the larger AAHPM community to advocate collectively to support our patients to get adequate insurance coverage for this critical medicine in our palliative pharmacopeia (4).

Approach: We discuss real-life cases where patients had barriers accessing buprenorphine leading to gaps in care and present successful strategies that helped patients overcome these barriers. We will also have small and large group discussions to identify opportunities for collective advocacy to advance nationwide solutions to redress these barriers to most effectively support our patients.

Implications/Lessons Learned: The audience will learn practical tips to support their patients with access to buprenorphine and identify strategies for collective advocacy for palliative care patients in pain.

References: 1. Case AA, Davis MP, Chwistek M, Zarrabi AJ. Buprenorphine for Cancer Pain-The Safest Opioid, and Patients With Cancer Cannot Get It. JAMA Oncol. 2025 Jun 5. doi: 10.1001/jamaoncol.2025.1337.
2. Case AA, Kullgren J, Anwar S, Pedraza S, Davis MP. Treating chronic pain with buprenorphine—the practical guide. Curr Treat Options Oncol. 2021;22(12):116.
3. Jones KF. Buprenorphine use in palliative care. J Hosp Palliat Nurs. 2019;21(6):540-547.
4. Neale KJ, Weimer MB, Davis MP, et al. Top ten tips palliative care clinicians should know about buprenorphine.J Palliat Med. 2023;26(1):120-130.