The purpose of this study is to develop and pilot test clinical guidelines for the use of
buprenorphine for the treatment chronic pain among patients with substance abuse histories.
Buprenorphine, an opioid medication, holds promise as a treatment of chronic pain because,
compared to most other opioid analgesics, it has a high safety profile, a low level of
physical dependence, and mild withdrawal symptoms on cessation. Moreover there are promising
reports from Europe of its use as a skin patch to treat chronic pain as well as clinical
reports in the U.S. that it may be effective when used sublingually (placed under the
tongue). This study will test the sublingual formulation.
Undergoing treatment for moderate-severe chronic pain for at least six months at either an
ambulatory practice of the Department of Pain and Palliative Medicine Beth Israel Medical
Center in New York City or the the Peter Kruger Clinic at the same institution.
1. On opioid therapy (any dose) and observed to have had at least four of the aberrant
drug-related behaviors described in (Passik et al. Clin J Pain; 22(2):173-81 2006)
during the past six months, or
2. Considered a candidate for long-term therapy by the pain specialist and a history of
a substance use disorder, as determined by DSM-IV criteria, but no longer meeting
criteria for at least one year.
- Meets DSM-IV criteria for current opioid dependence or other substance use disorder
including alcohol abuse.
- Currently being treated for opioid dependence with methadone.
- Currently maintained on naltrexone (e.g., for alcohol dependence).
- Taking benzodiazepines on a daily basis.
- A history of moderate-severe cardiopulmonary disease or symptoms or signs consistent
with moderate-severe cardiopulmonary disease.
- Elevated liver function test (LFT) results (> 2.5 above normal).