Talk 1: Acute and Chronic Pain Management: Screening, Diagnosis, Treatment of Opioid Use Disorders – covers:

• Prevalence of opioids as a treatment for acute and chronic pain in the US versus other nations
• The risks associated with prescription opioids for acute pain
• Recommended treatment for acute pain: alternatives to opioids and their relative efficacy (overall: non-opioids are more effective at treating pain)
• The risks associated with prescription opioids for chronic pain
• Alternative treatments to opioids for chronic pain (once again, more effective + less risk than opioids)
• An overview of MOUD/safe prescribing practices for buprenorphine

Key Open Access Research Papers on Acute and Chronic Pain Management, Opioid Use, and Alternatives

Below is a curated table of free, peer-reviewed research from PubMed addressing your requested topics, including opioid prevalence, risks, alternatives, and best practices for opioid use disorder (OUD) management.

Figure 1: Key open access studies on opioid use, pain management, and alternatives.

Summary of Key Findings

Prevalence and International Comparison

• The US has higher opioid prescribing rates for pain than most other nations, contributing to increased OUD risk (Nadeau et al., 2021; Dowell et al., 2022).

Risks of Prescription Opioids

• Acute pain: Short-term opioid use can lead to misuse, especially in high-risk patients; multimodal non-opioid strategies are recommended (Baumann et al., 2023; Dowell et al., 2022).
• Chronic pain: OUD risk from prescription opioids is likely under 3%, but long-term use increases risk; careful patient selection and monitoring are critical (Nadeau et al., 2021; Longo et al., 2016).

Alternatives to Opioids

• Non-opioid medications (NSAIDs, acetaminophen), regional anesthesia, and nonpharmacological interventions (physical therapy, CBT, mindfulness) are recommended as first-line for most acute and chronic pain (Dowell et al., 2022; Hargett et al., 2022; Archambault et al., 2024).
• Non-opioid and multimodal approaches can reduce opioid requirements and associated risks, though evidence for superiority over opioids in all cases is limited (Dowell et al., 2022; Hargett et al., 2022; Archambault et al., 2024).

MOUD and Safe Prescribing

• For OUD, continuing buprenorphine or methadone during acute pain episodes is generally supported; multidisciplinary planning and individualized care are essential (Buonora et al., 2025; Warner et al., 2020; Archambault et al., 2024).
• Integrated care models and shared decision-making improve outcomes for patients with co-occurring pain and OUD (Archambault et al., 2024; Warner et al., 2020).

Conclusion

Current evidence supports prioritizing non-opioid and multimodal pain management strategies, careful opioid prescribing, and integrated care for OUD. US opioid prescribing remains higher than in other countries, underscoring the need for guideline-based, individualized approaches.

These papers were sourced and synthesized using Consensus, an AI-powered search engine for research. Try it at https://consensus.app

References

Buonora, M., Mackey, K., Khalid, L., Hickey, T., Grimshaw, A., Moss, M., Starrels, J., Alford, D., Becker, W., & Weimer, M. (2025). Acute Pain Management in People With Opioid Use Disorder. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-24-01917

Baumann, L., Bello, C., Georg, F., Urman, R., Luedi, M., & Andereggen, L. (2023). Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors. Current Pain and Headache Reports, 27, 437 - 444. https://doi.org/10.1007/s11916-023-01127-0

Nadeau, S., Wu, J., & Lawhern, R. (2021). Opioids and Chronic Pain: An Analytic Review of the Clinical Evidence. Frontiers in Pain Research, 2. https://doi.org/10.3389/fpain.2021.721357

Archambault, L., Bertrand, K., Martel, M., Bérubé, M., Belhouari, S., & Perreault, M. (2024). The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review.. Journal of clinical nursing. https://doi.org/10.1111/jocn.17139

Dowell, D., Ragan, K., Jones, C., Baldwin, G., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports, 71, 1 - 95. https://doi.org/10.15585/mmwr.rr7103a1

Warner, N., Warner, M., Cunningham, J., Gazelka, H., Hooten, W., Kolla, B., & Warner, D. (2020). A Practical Approach for the Management of the Mixed Opioid Agonist-Antagonist Buprenorphine During Acute Pain and Surgery.. Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2019.10.007

Hargett, J., Criswell, A., & Palokas, M. (2022). Nonpharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance: a scoping review.. JBI evidence synthesis. https://doi.org/10.11124/JBIES-21-00169

Source: Consensus

Talk 2: Buprenorphine for OUD: Inpatient Settings, Adolescents, and Geriatrics

• Overview of MOUD initiation in inpatient/emergency department settings; current shortfalls
• Means to improve inpatient/ED MOUD, best practice for inpatient buprenorphine initiation
• Prevalence of OUD in adolescents
• Prescribing MOUD/buprenorphine to adolescents; barriers to care
• Prevalence of OUD in older adults
• Best practice for geriatric MOUD, drug-drug interactions + options with least risk for older patients

Buprenorphine for OUD in Inpatient, Adolescent, and Geriatric Populations: A Review of Free PubMed Research

This review summarizes recent open-access PubMed research on buprenorphine for opioid use disorder (OUD) in inpatient settings, adolescents, and older adults, focusing on MOUD initiation, barriers, and best practices.

Inpatient/ED MOUD Initiation: Overview, Shortfalls, and Best Practices

Initiating buprenorphine in hospitals and emergency departments improves linkage to outpatient care and reduces mortality, but remains underutilized due to regulatory barriers, lack of clinician readiness, and workflow challenges (Mospan & Chaplin, 2021; Christian et al., 2021; Koehl et al., 2019). Best practices include hospitalist-led programs, standardized protocols, and interprofessional teams, which have shown high rates of successful induction and outpatient linkage (up to 87% induction, 72% linkage in adolescents; 83% linkage in adults) (Trope et al., 2023; Christian et al., 2021; Camenga & Barelli, 2023). Microdosing and low-dose initiation strategies are effective and well-tolerated, especially for patients with co-occurring pain or fentanyl exposure (Spreen et al., 2022; Seval et al., 2023; Button et al., 2021; Vanini et al., 2024). Pharmacists and hospitalists play key roles in program development and legal compliance (Mospan & Chaplin, 2021; Kohan et al., 2021).

Improving Inpatient/ED MOUD: Strategies and Innovations

• Standardized protocols and electronic order sets facilitate implementation (Camenga & Barelli, 2023).
• Microdosing and low-dose induction reduce withdrawal risk and improve patient comfort (Spreen et al., 2022; Seval et al., 2023; Button et al., 2021; Vanini et al., 2024).
• Long-acting buprenorphine formulations enhance adherence and reduce diversion (Maremmani et al., 2023; Seval et al., 2023).
• Interprofessional teams and bridge prescriptions support continuity of care (Christian et al., 2021; Trope et al., 2023).

OUD Prevalence and MOUD in Adolescents: Barriers and Care

OUD prevalence among adolescents is rising, with nearly 80,000 affected in the US in 2020 (Camenga & Barelli, 2023). Despite proven efficacy, <5% of adolescents with OUD receive MOUD, largely due to limited access, regulatory barriers, stigma, and lack of trained providers (Trope et al., 2023; Borodovsky et al., 2018; Hadland et al., 2021; Camenga et al., 2019; Camenga & Barelli, 2023; Velagapudi et al., 2024). Inpatient induction protocols and long-acting injectable buprenorphine may improve adherence and outcomes (Trope et al., 2023; Allami et al., 2024; Velagapudi et al., 2024). Family involvement, youth-friendly care, and contingency management can further enhance retention (Allami et al., 2024; Wenzel et al., 2021).

OUD in Older Adults: Prevalence, Best Practices, and Safety

Research on OUD prevalence and MOUD in geriatrics is limited. Buprenorphine is favored for older adults due to a lower risk of respiratory depression and drug-drug interactions compared to methadone (Koehl et al., 2019; Bell & Strang, 2020). Individualized dosing, careful monitoring, and consideration of comorbidities are recommended (Koehl et al., 2019; Bell & Strang, 2020). Long-acting formulations may offer additional benefits in this population (Maremmani et al., 2023).

Buprenorphine for OUD: Inpatient, Adolescent, and Geriatric Populations

Figure 1: Summary of research on buprenorphine for OUD in key populations and settings.

These papers were sourced and synthesized using Consensus, an AI-powered search engine for research. Try it at https://consensus.app

References

Koehl, J., Zimmerman, D., & Bridgeman, P. (2019). Medications for management of opioid use disorder.. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 76 15, 1097-1103. https://doi.org/10.1093/ajhp/zxz105

Maremmani, I., Dematteis, M., Gorzelańczyk, E., Mugelli, A., Walcher, S., & Torrens, M. (2023). Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. Journal of Clinical Medicine, 12. https://doi.org/10.3390/jcm12175575

Bell, J., & Strang, J. (2020). Medication Treatment of Opioid Use Disorder. Biological Psychiatry, 87, 82-88. https://doi.org/10.1016/j.biopsych.2019.06.020

Trope, L., Stemmle, M., Chang, A., Bashiri, N., Bazazi, A., Lightfoot, M., & Congdon, J. (2023). A Novel Inpatient Buprenorphine Induction Program for Adolescents With Opioid Use Disorder.. Hospital pediatrics. https://doi.org/10.1542/hpeds.2022-006864

Kohan, L., Potru, S., Barreveld, A., Sprintz, M., Lane, O., Aryal, A., Emerick, T., Dopp, A., Chhay, S., & Viscusi, E. (2021). Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Regional Anesthesia & Pain Medicine, 46, 840 - 859. https://doi.org/10.1136/rapm-2021-103007

Spreen, L., Dittmar, E., Quirk, K., & Smith, M. (2022). Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review. Pharmacotherapy, 42, 411 - 427. https://doi.org/10.1002/phar.2676

Christian, N., Bottner, R., Baysinger, A., Boulton, A., Walker, B., Valencia, V., & Moriates, C. (2021). Hospital Buprenorphine Program for Opioid Use Disorder Is Associated With Increased Inpatient and Outpatient Addiction Treatment.. Journal of hospital medicine, 16 6, 345-348. https://doi.org/10.12788/jhm.3591

Seval, N., Nunez, J., Roth, P., Schade, M., Strong, M., Frank, C., Litwin, A., Levin, F., Brady, K., Nunes, E., & Springer, S. (2023). Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial. Journal of Addiction Medicine, 17, e232 - e239. https://doi.org/10.1097/ADM.0000000000001136

Button, D., Hartley, J., Robbins, J., Levander, X., Smith, N., & Englander, H. (2021). Low-dose Buprenorphine Initiation in Hospitalized Adults With Opioid Use Disorder: A Retrospective Cohort Analysis. Journal of Addiction Medicine, 16, e105 - e111. https://doi.org/10.1097/ADM.0000000000000864

Borodovsky, J., Levy, S., Fishman, M., & Marsch, L. (2018). Buprenorphine Treatment for Adolescents and Young Adults With Opioid Use Disorders: A Narrative Review.. Journal of addiction medicine, 12 3, 170-183. https://doi.org/10.1097/ADM.0000000000000388

Mospan, G., & Chaplin, M. (2021). Initiation of buprenorphine for opioid use disorder in the hospital setting: Practice models, challenges, and legal considerations.. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. https://doi.org/10.1093/ajhp/zxab373

Hadland, S., Aalsma, M., Akgül, S., Alinsky, R., Bruner, A., Chadi, N., Galagali, P., , F., Kreida, E., Robinson, C., & Wilson, J. (2021). Medication for Adolescents and Young Adults With Opioid Use Disorder.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. https://doi.org/10.1016/j.jadohealth.2020.12.129

Camenga, D., Colón-Rivera, H., & Muvvala, S. (2019). Medications for Maintenance Treatment of Opioid Use Disorder in Adolescents: A Narrative Review and Assessment of Clinical Benefits and Potential Risks.. Journal of studies on alcohol and drugs, 80 4, 393-402. https://doi.org/10.15288/jsad.2019.80.393

Allami, N., O’Connor, K., & Bagley, S. (2024). A case of severe opioid and methamphetamine use disorder in a 14 year old. Addiction Science & Clinical Practice, 19. https://doi.org/10.1186/s13722-024-00487-1

Wenzel, K., Selby, V., Wildberger, J., Lavorato, L., Thomas, J., & Fishman, M. (2021). Choice of extended release medication for OUD in young adults (buprenorphine or naltrexone): A pilot enhancement of the Youth Opioid Recovery Support (YORS) intervention.. Journal of substance abuse treatment, 125, 108306. https://doi.org/10.1016/J.JSAT.2021.108306

Camenga, D., & Barelli, P. (2023). It Is Time for Pediatric Hospitalists to Treat Opioid Use Disorder.. Hospital pediatrics. https://doi.org/10.1542/hpeds.2022-006940

Velagapudi, V., Schuster, L., & Sethi, R. (2024). Buprenorphine: two adolescent case reports of bridging the transmucosal form to the extended-release subcutaneous injectable form. Journal of Addictive Diseases, 42, 426 - 431. https://doi.org/10.1080/10550887.2023.2251366

Vanini, D., Corvelli, J., Maynard, K., Rappaport, S., Grasso, G., Jones, R., Acquisto, N., & Schult, R. (2024). Practices and Outcomes Associated With Sublingual Buprenorphine Use in a Critically Ill Population. Critical Care Explorations, 6. https://doi.org/10.1097/CCE.0000000000001062

Source: Consensus