Buprenorphine is an opioid analgesic available in Canada as transdermal patches and sublingual tablets (tablets also contain naloxone).^1,2 Buprenorphine/naloxone is indicated for substitution treatment in opioid drug dependence in adults whereas transdermal buprenorphine is indicated for the management of pain severe enough to require daily, continuous, long-term opioid treatment. Buprenorphine produces typical opioid agonist effects and in higher doses its agonist effects reach a ceiling and it can act as an antagonist. This property distinguishes it from morphine. It has high affinity for mu opioid receptors but only weakly activates them.³ For this reason, buprenorphine may be less likely to cause respiratory depression than full opioid agonists such as fentanyl or morphine.⁴ When buprenorphine is given concomitantly with other opioids, it antagonizes the effects of the other opioids by displacing them from the mu receptors. This can lead to withdrawal syndrome if buprenorphine is added to another opioid. If buprenorphine is withdrawn while the dose of the other opioid is being increased, it can increase the risk of overdose.³

The role of opioids in chronic cancer pain has been well established but their role and the relative effectiveness of opioids such as buprenorphine in the context of chronic non-cancer pain is unclear.

Contents

• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1. Selection of Included Studies
• APPENDIX 2. Characteristics of Included Publications
• APPENDIX 3. Summary of Critical Appraisal
• APPENDIX 4. Main Study Findings and Author’s Conclusions

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that the Canadian Agency for Drugs and Technologies in Health (CADTH) could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.