A Safer Opioid? Buprenorphine for Acute Pain in the ED
A Safer Opioid? Buprenorphine for Acute Pain in the ED
Jan. 1, 2026
Buprenorphine is well-known for opioid use disorder—but what about for acute pain? Drs. Terry Ahern and Jon Lee join host Maiya Smith to discuss low-dose buprenorphine for pain management in the emergency room, covering pharmacology, dosing, patient selection, and why it may be a safer, underused analgesic.
Host
Maiya Smith, MD
University of Utah
Emergency Medicine Residency Class of 2025
@Maiyaandtheadventuremutts
EMRA*Cast Episodes
OVERVIEW
Most emergency physicians know buprenorphine as a cornerstone treatment for opioid use disorder, but what if it could also be used as a safer, longer-lasting option for acute pain?
In this episode with EMRA*Cast, Dr. Terry Ahern and Dr. Jon Lee from Stanford join host Maiya Smith to discuss their department's experience using low-dose buprenorphine for acute pain management in the ED. They break down the pharmacology, dosing, patient selection, and real-world implementation, highlighting how buprenorphine can provide durable analgesia with a favorable safety profile compared to full opioid agonists. This conversation explores why buprenorphine may be an underutilized but practice-changing tool for emergency physicians.
TAKE-HOME POINTS
- Buprenorphine is a potent analgesic, not just a treatment for opioid use disorder; at low doses it can be safely used for acute pain in the ED.
- Buprenorphine’s pharmacology has a safer respiratory profile and lower abuse potential than traditional opioids
- ED dosing for pain is much lower than opioid use disorder dosing (eg, IV 90–150 mcg), and a little goes a long way.
- Ideal candidates include patients who would otherwise need IV opioids, including those with a history of opioid use disorder, while patients with severe liver disease or on chronic full-agonist opioids require caution.
- Successful implementation requires a multidisciplinary approach, including pharmacy, nursing, pain and addiction medicine, along with clear protocols and patient education.
References:
Lee JB, Ognian I, Park J, Coggins N, DeJulio P, Ashenburg N, Ahern T. From Addiction to Acute Pain Relief: A Narrative Review on Buprenorphine's Expanding Role in Emergency Department Pain Management. J Emerg Med. 2025;79:371-384.
