Journal Article Annotations
2025, 2nd Quarter

Palliative Medicine

Annotations by R. Garrett Key, MD
July, 2025

Providers’ Barriers to Buprenorphine Prescribing for Cancer-Related Pain.

PUBLICATION #1 — Palliative Medicine

Providers’ Barriers to Buprenorphine Prescribing for Cancer-Related Pain.

Katarina E AuBuchon, KerriAnn M Boanca, Nikhitha Muthineni, Melody A Emenyonu, Hannah Arem, Kristen McElreath

Abstract: J Pain Symptom Manage. 2025 May;69(5):e330-e336. doi: 10.1016/j.jpainsymman.2025.02.010. Epub 2025 Feb 16.

Background:
Full-agonist opioids are standard for treating cancer-related pain. However partial-agonist opioids (e.g., buprenorphine) are promising treatments with fewer side effects and a stronger safety profile. However, it is unclear how oncology and palliative care providers (Medical Doctors, Advanced Practice Providers, etc.) perceive prescribing of buprenorphine for cancer-related pain.

Methods:
Participants (N = 42; 50% oncology) at a single healthcare system with multiple hospitals completed a one-time web-delivered survey assessing reported opioid prescribing patterns and barriers to buprenorphine prescribing for cancer-related pain. Independent samples t- and chi-square tests compared palliative and oncology providers’ opioid prescribing and barriers to buprenorphine use; we examined how barriers related to intentions to prescribe buprenorphine with correlations.

Results:
Most participants reported awareness of buprenorphine for cancer-related pain (81%), and that buprenorphine is effective for treating cancer-related pain (80%), but few reported prescribing it (oncology 0%; palliative 5%). Oncology providers reported lack of knowledge about buprenorphine prescribing. Palliative care providers reported opioid stigma (61.7%) and patients’ difficulty obtaining buprenorphine (47.6%) were barriers. Prescribing participants’ future intentions to prescribe buprenorphine for cancer-related pain was significantly associated with endorsement that buprenorphine is as effective as (r = .53, P = .005), and that it causes fewer side-effects relative to (r = .59, P < .001) other opioids.

Discussion:
Our study identified knowledge gaps in cancer care teams about buprenorphine for cancer-related pain. Future research should consider education for oncology teams on buprenorphine, and how oncology and palliative care teams can benefit from working together to reduce stigma when communicating with patients about buprenorphine.

Annotation

The finding:
Buprenorphine is generally known by both oncologists to be effective for treating cancer pain. However, it is rarely prescribed due to a combination of barriers related to prescribing knowledge, stigma, and drug access.

Strength and weaknesses:
The main strength of this paper is it presents simple and clear findings that suggest areas where intervention could be effective. Weaknesses include a small and potentially homogenous sample from a single healthcare system that may not be representative of different areas or populations.

Relevance:
Opioid management and offering recommendations around analgesic strategies is a part of the scope of work for CL psychiatrists. Our familiarity with the use of buprenorphine in the context of pain, substance use disorders, and transitioning from full agonist opioids or co-administration of full-agonist opioids offers us the ability to advocate and educate colleagues and patients to improve penetration of buprenorphine into the analgesic armamentarium. It is an effective analgesic with advantages in safety profile and should be used more often for complex pain management needs.