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Buprenorphine transition from full mu agonists in pain medicine


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Hello and thank you for any feedback/guidance. Over the last several months I have been researching the expanded use of buprenorphine in my pain practice. Transitioning patients who are on low to medium meqs has been variably successful. For example I most recently transitioned an elderly pt who was taking 80meqs morphine to transbuccal buprenorphine 300ugm bid (according to dosing chart) and she is/was miserable in pain and some withdrawl symptoms.  While those with higher meqs remain a quandary. The challenges are numerous and to name just a few include limited insurance coverage of the pain formulated buprenorphine produces as well as the broad morpine equivalancies I find in the literature. Obviously I want these transitions to be successful as it is clearly a safer alternative for my pts. Yet when unsuccessful it taints the pt's willingness (which has associated anxiety to begin with) to try again. I appreciate the guidelines shared here. Is there a general consensus as to what 1mg of buprenorphine equates to mgs of morphine? Understanding all pts are not equal is there a ceiling of morphine equivalency that dictates the need for in office induction vs at home transition? Any pearls are appreciated.

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