Safety and Analgesic Outcomes of Low-Dose Buprenorphine for Acute Pain in the Emergency Department: A Retrospective Case Series.

BACKGROUND

Low-dose buprenorphine (LDB) has been proposed as an alternative analgesic. Its role in emergency department (ED) patients with undifferentiated acute pain remains underexplored.

OBJECTIVE

To describe the use, dosing patterns, and adverse events associated with LDB for acute pain in the ED.

METHODS

We conducted an institutional review board-approved retrospective, consecutive case series at a single urban adult ED from November 2024 to November 2025. Adult patients (≥18 years) who received LDB for analgesia-defined as 90-150 mcg intravenous (IV) or 0.5-1 mg sublingual-were included. Two physicians independently abstracted data using a standardized form. Adverse events were categorized as minor or serious. Numeric rating scale (NRS) pain scores at triage and ≥60 min after LDB administration were recorded when available. Concomitant analgesic use was assessed.

RESULTS

A total of 153 patients received LDB; most received a single IV dose (82%, typically 150 mcg). Adjunct analgesics were frequently co-administered. Sixteen patients (10%) experienced at least one adverse event, including 11 (7%) minor and 5 (3%) serious events. Two patients required naloxone; both had concurrent sedating exposures and comorbid risk factors identified on chart review. Among patients with follow-up documentation, mean NRS pain scores decreased from 8.5 (SD 1.9) at triage to 4.1 (SD 3.2) ≥60 min after LDB.

CONCLUSION

Adverse events following LDB administration were uncommon, but two cases required naloxone. LDB was associated with reduced pain scores, although causality cannot be established. Further study is needed to define safety, dosing, and appropriate patient selection.