Efficacy of transdermal buprenorphine patch for managing withdrawal symptoms in patients with cancer physically dependent on prescription opioids

• Published in: The oncologist (Dayton, Ohio) Vol. 29; no. 11; pp. e1593 - e1603
• Main Authors: Kang, Jung Hun, Lee, Kyung Hee, Huh, Seok Jae, Shin, Seong-Hoon, Kim, Il Hwan, Hwang, In Gyu, Koo, Dong-Hoe, Lee, Dongyun, Koh, Su-Jin, Seo, Seyoung, Lee, Guk Jin, Chun, Sang Hoon, Ji, Jun Ho, Oh, Sung Yong, Choi, Jung Woo, Go, Se-Il
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.11.2024
• Subjects: Adult; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - administration & dosage; Buprenorphine - therapeutic use; Cancer; Cancer patients; Dosage and administration; Drug therapy; Drug withdrawal; Drug withdrawal symptoms; Female; Humans; Male; Middle Aged; Narcotics; Neoplasms - complications; Neoplasms - drug therapy; Opioid-Related Disorders - drug therapy; Prescription drugs; Prospective Studies; Substance Withdrawal Syndrome - drug therapy; Symptom Management and Supportive Care; Testing; Transdermal medication; Transdermal Patch; South Korea; substance withdrawal syndrome; buprenorphine; opioid-related disorders; cancer survivors; prescription drugs
• ISSN: 1083-7159; 1549-490X; 1549-490X
• DOI: 10.1093/oncolo/oyae176

Background The physical dependence on prescription opioids among cancer survivors remains an under-investigated area, with a scarcity of well-designed prospective studies. Methods This single-arm, phase-2 clinical trial in Korea assessed the efficacy and safety of a transdermal buprenorphine patch (TBP) in managing physical dependence on prescription opioids in cancer survivors, as confirmed through the DSM-5 criteria or psychiatric consultation for opioid withdrawal. This study involved a 4-phase treatment protocol of screening, induction/stabilization, discontinuation, and monitoring. The primary outcome was the rate of successful opioid discontinuation, as measured by a negative urine-drug screening at 8 weeks. Key secondary outcomes included the resumption of prescribed opioids, changes in both the Clinical Opioid Withdrawal Scale (COWS) and morphine equivalent daily dose (MEDD), and assessments related to the psychological and physiological aspects of dependence and safety. Results Thirty-one participants were enrolled. In the intention-to-treat population, the success rate of opioid discontinuation was 58%, with only 2 participants experiencing a resumption of prescribed opioids. Significant reductions were observed in MEDD, which decreased from 98 to 26 mg/day (P < .001), and COWS scores, which decreased from 5.5 to 2.8 (P < .001). Desire to use opioids reduced from 7.0 to 3.0 on a 10-point numeric rating scale (P < .001). Toxicities related to TBP were mild and manageable, without severe precipitated withdrawal symptoms. Conclusion TBP may be considered as an alternative therapeutic option in cancer survivors physically dependent on prescription opioids, especially where sublingual formulations are unavailable. The transdermal buprenorphine patch may offer a promising approach for managing physical dependence on prescription opioids in cancer survivors. Graphical Abstract Graphical Abstract