great article reminding us not to stop buprenorphine in patients with opioid use disorder who have acute pain. a few key points are worth emphasizing ...1/5
(full article: bit.ly/2L9m8FP)
most important point = don't stop buprenorphine due to acute pain! dividing the bupe dose q6-q8 may improve analgesic effectiveness, so buprenorphine itself can be used as an analgesic. (2/5)
you don't need an X-waiver to prescribe buprenorphine within the hospital. using buprenorphine is now a core clinical competency that all inpatient providers should be comfortable with (3/5)
high-potency full opioids may be added on *top* of buprenorphine to help manage acute pain (e.g. morphine). the dose will need to be increased to compete for receptors, but this can still work (4/5)
don't forget multimodal tx (acetaminophen, ketamine, clonidine, dexmedetomidine, ketamine, gabapentin, did I mention ketamine?). tickling more receptors often better than whaling on the mu-receptors with tons of opioid. more on this in @iBookCC here bit.ly/30JtEOo (5/5)
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