Buprenorphine Continuation During Critical Illness Associated With Decreased Inpatient Opioid Utilization In Individuals Maintained On Buprenorphine For Opioid Use Disorder In A Retrospective Study

Aurora Quaye, Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.
Chelsea Wampole, Department of Pharmacy, Maine Medical Center, Portland, ME, USA.
Richard R. Riker, Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
David B. Seder, Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
William J. Sauer, Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.
Janelle M. Richard, Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.
Wendy Y. Craig, MaineHealth Institute for Research, Scarborough, ME, USA.
David J. Gagnon, Department of Pharmacy, Maine Medical Center, Portland, ME, USA.

Abstract

The number of patients maintained on buprenorphine is steadily increasing. To date, no study has reported buprenorphine management practices for these patients during critical illness, nor its relationship with supplemental full-agonist opioid administration during their hospital stay. In this single-center retrospective study we have explored the incidence of buprenorphine continuation during critical illness among patients receiving buprenorphine for the treatment of opioid use disorder (OUD). Additionally, we investigated the relationship between non-buprenorphine opioid exposure and buprenorphine administration during the intensive care unit (ICU) and post-ICU phases of care. Our study included adults maintained on buprenorphine for OUD admitted to the ICU between December 1, 2014 and May 31, 2019. Non-buprenorphine, full agonist opioid doses were converted to fentanyl equivalents (FEs). 51 (44%) patients received buprenorphine during the ICU phase of care with an average dose of 8 [8-12] mg/day. During the post-ICU phase of care, 68 (62%) received buprenorphine with an average dose of 10 [7-14] mg/day. Lack of mechanical ventilation and acetaminophen use were also associated with buprenorphine use. Full agonist opioid use was more frequent on days when buprenorphine was not given (OR 6.2, 95% CI 2.3-16.4; p<.001). Additionally, the average cumulative dose of opioids given on non- buprenorphine administration days was significantly higher both in the ICU (1803 (1271-2553) vs 327 (152-708) FEs/day (p<.001)) and post ICU discharge (1476 (962-2265) vs 238 (150-377) FEs/day (p<.001)). Given these findings, buprenorphine continuation during critical illness should be considered, as it is associated with significantly decreased full agonist opioid utilization. This article is protected by copyright. All rights reserved.