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Sublingual Buprenorphine for Chronic Pain: A Survey of Clinician Prescribing Practices

Rosen, Kristen MPH*; Gutierrez, Antonio MS*; Haller, Deborah PhD; Potter, Jennifer S. PhD, MPH*,‡

doi: 10.1097/AJP.0b013e318298ddad
Original Articles

Objectives: Sublingual buprenorphine, with and without naloxone, is indicated for the treatment of opioid use disorders. Although not approved for pain, some evidence suggests it may be a safe and effective alternative to conventional opioid analgesics, particularly for those with addiction problems. This study surveyed pain specialists to examine the extent to which sublingual buprenorphine was prescribed for chronic pain and explore associated clinician attitudes and characteristics.

Method: A 36-item survey examining clinician attitudes and characteristics related to sublingual buprenorphine and other opioids was distributed to 1307 members of the American Pain Society, a multidisciplinary professional group. Members were provided a paper copy of the survey and URL to an online version. A follow-up letter was mailed after 2 weeks.

Results: Overall, 230 completed surveys were returned (18.5%). Of clinicians who prescribed opioids for chronic pain (92.5%), 19.7% reported prescribing sublingual buprenorphine for chronic pain at least once; of these prescribers, 39.6% did not have a DEA X-waiver to prescribe sublingual buprenorphine for opioid dependence. Prescribers were more likely than nonprescribers to find sublingual buprenorphine effective for chronic pain. Prescribers were also significantly more likely to view sublingual buprenorphine as safer than full agonists in terms of addiction, overdose, and drug interaction. No differences emerged between prescribers and nonprescribers regarding perceptions of potential for drug diversion or in terms of overall opioid prescribing behaviors.

Discussion: Results suggest that sublingual buprenorphine is indeed being used to treat chronic pain; however, the circumstances when this occurs are not entirely clear.

*Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX

St Luke’s Roosevelt Hospital Center, Columbia University, New York, NY

Harvard Medical School, McLean Hospital, Belmont, MA

Presented at the American Pain Society Annual Scientific Meeting, May 2011, Austin, TX.

The authors declare no conflict of interest. Supported by K23 DA022297 (J.S.P.) from the National Institute on Drug Abuse, Bethesda, MD.

Reprints: Jennifer S. Potter, PhD, MPH, Department of Psychiatry, University of Texas Health Science Center San Antonio, 7526 Louis Pasteur MC7733, San Antonio, TX 78229 (e-mail:

Received June 22, 2012

Accepted April 15, 2013

© 2014 by Lippincott Williams & Wilkins