Managing Legacy Opioid Patients, Patients with Comorbid Substance Use, and a Role for Buprenorphine for Pain

The 2010s saw a dramatic shift in the approach to prescribing opioid medications for chronic pain. Fueled by a growing understanding of abuse potential, the opioid epidemic, and later, a misapplication of the 2016 Centers for Disease Control and Prevention (CDC_ Guideline for Prescribing Opioids for Chronic Pain, many clinicians stopped both initiating opioid treatment and continuing treatment for legacy opioid patients, many of whom had been on high doses for years. Similarly, patients with active or past addiction found limited options for pain treatment, often stigmatized by staff in health care settings, thus increasing their risk of substance use and mental health crisis.