Buprenorphine in the Intensive Care Unit: Commentary on the Unanswered Questions

Author:

Gagnon David J.123,Glenn Melody J.45,Quaye Aurora A.367ORCID,Erstad Brian L.8ORCID

Affiliation:

1. Department of Pharmacy, Maine Medical Center, Portland, ME, USA

2. MaineHealth Institute for Research, Scarborough, ME, USA

3. Tufts University School of Medicine, Boston, MA, USA

4. Banner–University Medical Center Tucson Base Hospital, Tucson, AZ, USA

5. Emergency Medicine & Psychiatry, University of Arizona College of Medicine–Tucson, Tucson, AZ, USA

6. Department of Anesthesiology & Perioperative Medicine, Maine Medical Center, Portland, ME, USA

7. Spectrum Healthcare Partners, South Portland, ME, USA

8. University of Arizona College of Pharmacy, Tucson, AZ, USA

Abstract

The removal of the X-waiver in the Mainstreaming Addiction Treatment (MAT) Act of 2023 has substantial implications for buprenorphine prescribing as one of the options to treat opioid use disorder. The purpose of this commentary is to discuss the unanswered questions regarding buprenorphine in the intensive care unit (ICU) including how the passage of the MAT Act will affect ICU providers, which patients should receive buprenorphine, what is the most appropriate route of administration and dose of buprenorphine, what medications interact with buprenorphine, and how can transitions of care be optimized for these patients.

Publisher

SAGE Publications

Reference22 articles.

1. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

2. Substance Abuse and Mental Health Services Administration. Waiver elimination. Published October 10, 2023. Accessed February 5, 2024. https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act

3. Muoio D. With the X-Waiver repealed, officials urge providers to begin prescribing buprenorphine for opioid addiction. Fierce Healthcare. Published January 24, 2023. Accessed February 5, 2024. https://www.fiercehealthcare.com/providers/x-waiver-repealed-officials-urge-providers-begin-prescribing-buprenorphine-opioid

4. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

5. U.S. Adult Critical Care Beds Per Capita: A 2021 County-Level Cross-Sectional Study

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