(110) Buprenorphine Initiation in Patients With Acute Burns and Opioid Use Disorder

Introduction: Substance use disorder (SUD) management can be complicated by concurrent pain control in patients with burn injury. Multiple ways exist to transition to buprenorphine. Micro-dosing may offer advantages over conventional dosing due to high concurrent opioid requirements. The aim of this study is to analyze the transition process to buprenorphine in patients with acute burn injuries with SUD.

Methods: In this retrospective chart review, primary inclusion criteria include adults ≥ 18 years who had a burn injury and SUD ICD-10 diagnosis upon admission. The primary outcome is to determine factors that influence whether a patient continued on buprenorphine therapy or not. Therapy continuation is defined as continuation for at least one month after discharge. Multiple outcomes were assessed which included medication adherence to buprenorphine transition plans, buprenorphine transition plan including micro-dosing versus the California Bridge Quick Start protocol, oral morphine equivalent (OME) administered 24 hours prior to buprenorphine initiation, and prior to admission (PTA) buprenorphine. The Controlled Substance Utilization Review and Evaluation System (CURES) database was utilized to analyze patients' fill history upon discharge. A multivariate regression analysis was conducted using Stata SE.

Results: From January 2010 to October 2023, 107 patients with acute burn injury and SUD were analyzed. A majority of buprenorphine naïve patients (76%) were transitioned to buprenorphine via a microdosing strategy. Our primary outcome showed a high proportion (71%) of patients continued buprenorphine therapy at least one month from discharge. A multivariate regression analysis suggested that higher in-patient OME use >30 mg per day was inversely correlated with continuing buprenorphine (p-value = 0.029). However, other factors such as PTA buprenorphine use did not seem to be a significant factor on continuation (p-value = 0.263) nor did patients with >10% TBSA (p-value = 0.58).

Conclusions: There was a relatively high continuation of buprenorphine after discharge. Findings from this study may aid in the development of a transition approach for buprenorphine in patients with OUD and acute burn injuries.