A Safer Opioid? Buprenorphine for Acute Pain in the ED
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
Guest
Terence Ahern, MD
Clinical Assistant Professor
Department of Emergency Medicine
Stanford University
Jon Lee, MD
Clinical Assistant Professor
Department of Emergency Medicine
Department of Anesthesiology, Perioperative, and Pain Medicine
Stanford University
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.