512: Opioid Requirements in Ventilated Patients Taking Buprenorphine/Naloxone Prior to Admission

Introduction: With limited data quantifying opioid requirements based on substance use history, including buprenorphine/naloxone use, optimal pain management for mechanically ventilated patients remains unknown. The objective of this study is to compare opioid requirements in mechanically ventilated adults admitted to the intensive care unit (ICU) who take buprenorphine/naloxone prior to admission compared to those who do not. Methods: This multicenter, retrospective, observational study included adults admitted to a medical ICU and mechanically ventilated for at least 12 hours between July 1, 2013 and June 1, 2024. The primary endpoint was mean hourly opioid rate expressed in fentanyl equivalents (FE, mcg FE/hour) from intubation until extubation or up to 72 hours, whichever occurred first. Secondary endpoints included sedative requirements and time with pain and depth of sedation scores within goal, duration of mechanical ventilation, and survival to ICE and hospital discharge. To adjust for confounding variables, a negative binomial model on the average hourly opioid rate was performed. Results: A total of 176 patients were included with 47 in the buprenorphine/naloxone group, 69 in the opioid-naïve group, and 60 in the opioid-tolerant group. There was no difference in mean hourly opioid rate between buprenorphine/naloxone patients (40.8 ± 37.1 mcg FE/hour) and opioid-naïve (31.7 ± 32.5 mcg FE/hour; p=0.17) and opioid-tolerant patients (51 ± 46 mcg FE/hour; p=0.22). Multivariable regression demonstrated similar hourly rates in buprenorphine/naloxone and opioid-naïve patients, but opioid-tolerant patients had 50% higher rates (estimated rate ratio 1.5, 95% CI 1.01, 2.23). Time spent with pain scores at goal was similar between groups. Time spent with sedation scores at goal was similar between buprenorphine/naloxone and opioid-naïve patients, but was lower than opioid-tolerant patients. Conclusions: Mechanically ventilated patients taking buprenorphine/naloxone prior to admission may have opioid requirements similar to opioid-naïve patients and significantly lower than opioid-tolerant patients.