(1027) Use of Low-Dose Buprenorphine Initiation in Trauma Patients With Opioid Use Disorder

Introduction: Opioid use disorder (OUD) is a public health crisis in the United States. Hospitalization is an opportunity for initiation of medication-assisted treatment (MAT) for patients with OUD, including buprenorphine. Due to its properties as a partial agonist, buprenorphine can precipitate withdrawal, particularly in those who remained on full opioid agonist. A growing data suggested low-dose buprenorphine induction—administration of small incremental doses of buprenorphine over the first several days of treatment initiation with therapeutic dose titration—allows for immediate MAT initiation, while providing adequate pain control and minimized withdrawal. This strategy is particularly useful in trauma patients with OUD, as acute pain control is needed during hospitalization. However, data for the use of this strategy in the trauma patients are lacking.

Methods: This is a retrospective cohort study of patients who underwent low-dose buprenorphine initiation at an urban academic, level-1 trauma center between May 1st 2022 to Jan 31st 2023. Outcomes evaluated included duration and completion of induction, opioid requirements (in oral morphine equivalents, OME) prior to and at end of induction and at discharge, hospital length of stay (LOS), and whether buprenorphine was prescribed at discharge.

Results: A total of 36 patients were evaluated. Median age was 39 years, and majority male (66.7%). Most patients had blunt trauma (n=12, 33.3%) and wound/soft tissue infection (n=13, 36.1%), followed by penetrating trauma (n=8, 22.2%). Twenty-six patients (72%) were not on any MAT on admission. Baseline opioid requirements for the entire cohort was 117.5mg. Twenty-nine patients completed induction (80.6%). Median induction duration was 36 hours and LOS was 9 days. Among those who completed induction, median OMEs prior to, at end of induction and discharge were 117.5mg, 85mg, and 50mg, respectively. One patient was transitioned to methadone mid-titration due to withdrawal symptoms. Twenty-six patients (90%) were discharged with buprenorphine prescriptions after completion of induction.

Conclusions: Low-dose buprenorphine initiation resulted in successful initiation of buprenorphine in trauma patients with OUD. Hospitalization presents an opportunity to engage this high-risk population into MAT treatment.