Thread by @kfjonespallnp

🚨Everything you ever WANTED & NEEDED to know about buprenorphine in a single resource.

liebertpub.com/doi/abs/10.108…

Must-read for #hapc #NurseTwitter #socialwork #PharmD #MedTwitter #PA

📒Add to your fellowship required reading

Teaser 🧵on what you will find in the paper/1

Tip 1: Buprenorphine has Unique Pharmacology & < S/E Compared to Full Agonist Opioids
‘‘partial’’ is based on a comparison of protein activation in vitro studies
🔊does not mean partial analgesic
🔊does not mean partial analgesic
🔊does not mean partial analgesic/2

Tip 2:Buprenorphine may be the preferred opioid analgesic in selected patient populations.

In case you aren't convinced.

Analgesic efficacy is = and maybe > than oxycodone, fentanyl, hydromorphone, hydrocodone, and morphine/3
pubmed.ncbi.nlm.nih.gov/34079354/

Tip 3:Multiple Buprenorphine Formulations Are Available
Product Selection Is Determined by Several Factors
💊Opioid Tolerance
👥Clinical Indication
🤔Patient Preference
🪪Insurance Factors (sigh)
⏹️Exposure to a Full Agonist/4

Tip 4: Buprenorphine Is a Highly Effective for OUD

📢 lifesaving treatment for individuals with OUD
✨Reduces opioid cravings, opioid use, all-cause and overdose-related mortality
🌠 promotes improved QOL/5

Tip 5: Buprenorphine can be a useful harm reduction tool.
A reminder of the principles of harm reduction (harmreduction.org) @HarmReduction

For a deeper dive❤️Read one of my fav books: Undoing Drugs @maiasz /6

Tip 6: There Are Several Methods to Initiate Buprenorphine Therapy, Depending on Clinical Circumstances and Available Formulation

For more pearls, see recent @CurbsidersSUDs podcast @CarolynAChan @NanouTheNomad @ShawnCohen_MD
@ACAAMorg /7

Tip 7: Published Bup Equianalgesic Conversions should be tossed into 🗑️

Perhaps all opioid conversions charts
See @drosielle @Pallimed @GeriPalBlog @mlmcpherson

Should know about rough = b/t bup products
@DrMelissaWeimer paper/8 pubmed.ncbi.nlm.nih.gov/34823729/

Tip 8: Continue Bup for Acute Pain or in the Perioperative Period

Consensus guidelines pubmed.ncbi.nlm.nih.gov/34385292/

-Multimodal analgesia ( adjuvants,ketamine, blocks)
@JakeStrandMD @MihirKamdarMD looking at u
-divide into TID dose
-Consider temp dec Bup to 12–16 mg SL /9

Tip 9: Actively Dispel Misconceptions &Stigma R/t Bup Use
✖️Bup does not replace one ‘‘addiction’’ for another.
🆕Bup initiation strategies limit the risk of significant withdrawal & pain
👩‍⚕️Prescribing Bup for OUD is w/i our lane #hapc specialists/10
liebertpub.com/doi/abs/10.108…

Tip 10: Prescribing bup to individuals with serious illness helps address suffering

See our @GeriPalBlog @AMERSA_tweets @Pallimed @CAPCpalliative work & @DianeEMeier fireside chat w @JessicaMerlinMD /11

Shout-outs:
@DrKyleNealeHPM, who lead and circulated drafts w witty titles like "Bup there it is" & managed 14 authors

@ZacharySagerMD, who had the idea

@PCRCGroup led by @JessicaMerlinMD that brought many of us together

@CAJonesMD, who said YES to pitch
All co-authors/end