Buprenorphine a Safer Alternative for Opioid Use Disorder, Chronic Pain in the Elderly?

Fran Lowry

January 14, 2020

SAN DIEGO ― For older individuals with opioid use disorder (OUD) resulting from treatment of chronic pain, buprenorphine may be a safer pain management alternative, new research suggests.

Results from a literature review conducted by investigators at the University of Kansas Medical Center, Kansas City, indicate that buprenorphine, an opioid used to treat OUD as well as chronic and acute pain, may be a better choice for pain management in chronic pain patients older than 65 years who have become addicted to opioids.

Dr Dheepthi Ravishankar

Results of the review show that in general, there is evidence to support the use of buprenorphine in older patients. It is well tolerated, it has few side effects, and it can improve pain control, study investigator Dheepthi Arakonam Ravishankar, MBBS, told Medscape Medical News.

"Some of these patients had poor pain control, poor quality of life, and these improved after buprenorphine was initiated," she added.

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 30th Annual Meeting.

A Growing Problem

Addiction is a growing problem among the elderly. In the United States, the number of Americans aged 50 years or older who have a substance use disorder is set to double, from 2.8 million in the years 2002–2006 to 5.7 million in 2020.

Many older individuals develop OUD after years of prescription opioid use to treat chronic pain. However, with aging comes drug metabolism changes that increase the risk for adverse events, including organ damage.

"We have noticed that over the years, our patient population [with OUD] has changed from mostly heroin-using young adults to older patients who have been receiving prescription opioids for chronic pain but are now being sent to the addiction clinic due to development of opioid use disorder," lead investigator Roopa Sethi, MD, told Medscape Medical News.

This shift in the clinic's clientele, she added, prompted the investigators to conduct a literature review to determine the optimal treatment for this patient population.

In all, they found nine studies on OUD in elderly patients, four of which focused specifically on the use of buprenorphine for chronic pain in the elderly.

Results showed that buprenorphine was effective as a treatment for chronic pain in patients aged 65 to 84 years. The response was better among those aged 80 years or older than among those younger than 80.

Buprenorphine also decreased sleep disturbances caused by pain, and it improved quality of life.

The medication was well tolerated. Reported side effects included constipation, nausea, dizziness, vomiting, and respiratory depression in more elderly, frail patients.

A Critical Issue

Commenting on the findings for Medscape Medical News, Carla Marienfeld, MD, addiction psychiatrist and associate professor at the University of California, San Diego, said the study sheds light on a "critical issue."

She added that in her own practice, she has seen a "huge shift" in the number of older patients referred to her with chronic pain who are struggling with OUD.

These findings, she said, are "especially helpful" for psychiatrists. Even though psychiatrists don't treat pain, it is useful for them to understand that a drug such as buprenorphine, which is used to treat OUD, can be beneficial for other comorbid conditions such as pain.

Marienfeld believes that psychiatrists, including addiction psychiatrists, may not be aware that buprenorphine has fewer side effects, less impact on immune response, and typically requires fewer dose adjustments than other opioids.

She often has to advise surgeons, dentists, and other providers who are the first managers of pain but who may not be aware of the nuances of such management.

These findings, she said, aid clinicians' decision making "about what we might do to help this new, older population we are now beginning to see in our addiction clinics."

Sethi, Ravishankar, and Marienfeld report no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 30th Annual Meeting: Abstract 13. Presented December 08, 2019.

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