P-107 - (Poster #107) EVALUATING OUTCOMES OF TRANSITIONING FROM FULL OPIOID AGONIST USE TO BUPRENORPHINE

Patients were included if they had chronic pain (more than 3 months) between June 2021 and June 2024, were prescribed full opioid agonist before transitioning, and were 18 years of age or older during the study period. Pharmacy claims were used to identify opioid prescribed prior to transitioning to buprenorphine, dispense date, quantity prescribed, and Morphine Milligram Equivalent (MME). Patients were grouped by baseline opioid use into MME categories of less than 50, 50 to 100, and greater than 100. Successful transition, defined as transitioning to buprenorphine with no further need for full opioid agonist use. Exclusion criteria included buprenorphine outside of the study period, sickle cell pain, opioid use disorder, cancer pain, and treatment managed outside KPWA chronic pain clinic. 

The primary outcome of interest was the likelihood of successful transition stratified by patient characteristics including age, mental health diagnosis, pre-transition MME, and P</span>ain, Enjoyment, and General (PEG) scores. The secondary outcomes of interest were the differences in pre-transition MME by outcome and changes in PEG scores after transitioning to buprenorphine, each assessed with separate t-test. A logistic regression was used to evaluate the likelihood of successful transition for various patient characteristics. Statistical significance was set at P< .05. 



Results:

Of 30 patients who met eligibility criteria, 60% (n=18) successfully transitioned to buprenorphine, whereas 40% (n=12) were unable to complete the transition successfully. The average age of all patients included in the study was 64 years and 53% of patients were female. The average baseline PEG score prior to transition was 7.42. Stratified by outcome, the mean pre-transition PEG score was 6.57 in the successful group, and 8.21 in the unsuccessful transition group. Following the transition, the overall mean PEG score decreased to 6.51. Mental health diagnoses were documented in 63% of the total patient population, with 61% of patients in the successful transition group and 67% in the unsuccessful group having at least one mental health diagnosis recorded. The average morphine milligram equivalent (MME) among all participants included in the study (n=30) was 51.5.    

The logistic regression found no statistical associations between age, gender, mental health diagnosis, or pre-transition MME and successful transition to buprenorphine. There was no significant change in PEG scores before and after the transition to buprenorphine. There was no statistically significant difference in pre-transition MME between patients who successfully transitioned to buprenorphine and those who did not, as determined by t-test (p=0.33). 


Conclusions/Implications for future research and/or clinical care: This retrospective study explored potential factors influencing successful transition from full opioid agonist to buprenorphine for chronic pain management. Trends indicate that female gender, age over 71, and a pre-transition MME below 50 might be associated with successful outcome, though these did not reach statistical significance. Similarly, while lower pre-transition MME showed a descriptive pattern towards success, statistical tests did not confirm this relationship. The absence of significant predictors highlights the need for future research with larger, more diverse populations, and standardized definitions of success. Further investigation into opioid use history, therapy duration, and psychological factors may offer deeper insight into optimizing transition outcomes and reducing long-term opioid risk.