P-001 - (Poster #1) Reduction of 1,000,000 Monthly MME's to Zero Utilizing Buprenorphine and BHC Centered Care for Chronic Pain Patients in Federally Qualified Health Center: A One Year Project

Purpose: The purpose of this abstract is to outline our year-long program with success in reducing patients on full opioids from over 1 million practice MMEs per month in January 2024 to zero by October 2024 without inappropriately deprescribing opioids, or generating unnecessary suffering.  Barriers to care include insurance issues (formularies often prefer full opioids over buprenorphine), transportation, cost, patient attitudes and beliefs about buprenorphine, man hours required for counseling, education, reinforcement, especially in contrast with full opioids.  Dr. Cody collected data and will present separate data on attitudes and perspectives on buprenorphine in our patient population in a SC Federally Qualified Health Center with a large rural population.



Methods: This is a case series outlining transition off full opioids in 1091 patients, utilizing buprenorphine. Patients with opioid use disorder had been screened out of our practice and referred for assessment and treatment for substance use disorder prior to our MME reduction project.  Patients with problematic urines were discharged back to referring physicians or were able to alter lifestyle with BHC support.  For patients with insurance coverage or access to microdose formulations of buprenorphine (Belbuca or Butrans), we reduced MMEs in individual patients by 10 to 30 %/month in order to avoid negatively impacting ADLs, and once under 50 MMEs, added in microdose formulation of buprenorphine, then weaned off of full opioid within 2 to 6 weeks of starting Belbuca or Butrans, often with buprenorphine dose adjustment (upwards) as needed.  For patients without access to microdose formulations of buprenorphine, we stopped full opioids (24 hours for immediate release opioids) and scheduled an in-office buprenorphine tablet induction, along with Zofran, with close follow-up for buprenorphine dose adjustments as needed.  For patients on long-acting/ER opioids, we transitioned to IR opioids and then scheduled buprenorphine induction.  Our pharmacy worked to develop  buprenorphine assistance p</span>rogram for low income patients to facilitate access to buprenorphine. 

Results: Practice MMEs were significantly reduced month-to-month from 1 million practice MMEs in January 2024, to 252,000 by April 2024, 55,000 by July 2024, and ZERO by December 2024.  Some patients sought care elsewhere (about 35 %); many of those have returned as they have found difficulty in finding providers for full opioids.  Some patients (10-15%) weaned off of opioids completely, including buprenorphine and are doing well on nonopioid care, often utilizing acupuncture, chiropractic, pain skills group, one-on-one counseling, and lifestyle changes (weight loss, paced exercise).  Throughout transition, we have emphasized the 2 primary goals of chronic pain management 1. physical reconditioning and 2. cognitive reframing. 

Conclusions/Implications for future research and/or clinical care: South Carolina has one of the highest opioid overdose increases in the past several years.  The Pee Dee Region (Florence, South Carolina) has one of the highest in the state.  Buprenorphine is a safe, effective, long-acting opioid analgesic for patients with chronic pain.  Its improved safety profile (Ceiling effect on respiratory depression) its long acting nature, its activity at the opioid receptors mae it ideal for long-term use, especially in at risk populations such as patietns over 65 years old.