Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Figures & data

Table 1 There are Multiple Reasons Why the Transdermal Buprenorphine System May Be Underutilized for Pain Control

Reason for Not Prescribing Transdermal Buprenorphine for Pain in Otherwise Appropriate Patients	Response, Comments
Physician is not comfortable prescribing opioids in general	Pain relief sometimes requires opioid analgesics; prescribers who are not comfortable with opioid prescribing should refer the patient to a pain specialist
Physician is not comfortable prescribing transdermal buprenorphine	No X-waiver is required; it is indicated for pain; it has low rates of abuse; the patch assures good patient compliance
Physician is not aware that buprenorphine is appropriate for pain control; it’s for opioid maintenance	The transdermal buprenorphine patch is indicated for pain control
Prescribing buprenorphine patches will bring regulatory or legal scrutiny on the hospital or clinic	The judicious and prudent prescribing of opioid analgesics is likely within the scope of sound routine practice; buprenorphine and in particular transdermal buprenorphine has a reduced potential for misuse as it is not well liked by recreational users and the patch makes it difficult to extract the opioid agent
Insurance does not reimburse for transdermal buprenorphine	This varies by region and case; contact your provider. In many cases, transdermal buprenorphine is a good and defensible choice for analgesia
It is difficult to dose the patch	Patches come in multiple sizes and can be cut to reduce dose or more than one patch can be used for higher doses
Since transdermal buprenorphine is not indicated for acute pain, it is better not to use it	The transdermal buprenorphine system is safe and effective for appropriate chronic pain patients and its use for acute pain, although not specifically indicated, is reasonable and in some cases may be an optimal choice

Table 2 Commercial Names and Indications for Buprenorphine Products

Commercial Name	Manufacturer	Description	Use
Belbuca	BioDelivery Sciences International	Buccal film	Pain control
Buprenex	Reckitt Benckiser	Injectable	Pain control
Butrans	Teva	Transdermal system	Pain control
Sublocade	Indivior	Injectable	Opioid maintenance
Suboxone SL Film	Reckitt Benckiser	Buccal film	Opioid maintenance
Suboxone SL Tablet		Oral buprenorphine/naloxone	Opioid maintenance
Subutex		Sublingual tablet	Opioid maintenance
Transtec	Grünenthal	Transdermal system	Pain (Europe)
Zubsolv	Orexo	Sublingual tablet	Opioid maintenance

Note: Product names may be trademarks or registered trademarks of their respective owners.