Indiana VA Training Improves Buprenorphine Prescribing Confidence

An Indiana VA medical center conducted a pharmacy-led education project. It improved clinicians’ reported knowledge and confidence about buprenorphine for chronic pain, offering a training model that may also interest medical detox teams managing complex opioid histories.

The quality improvement project published in Federal Practitioner used brief presentations created and delivered by advanced practice pharmacy students and pain clinical pharmacist practitioners.

The Buprenorphine for Chronic Pain Educational Experience took place at Veteran Health Indiana, which serves more than 62,000 veterans through a tertiary medical center in Indianapolis and 14 community-based outpatient clinics.

What the Pharmacy-Led Program Did

Three advanced practice pharmacy students developed an evidence-based presentation during a four-month track program with the Richard L. Roudebush VA Medical Center. They reviewed guidelines and built a theoretical patient case involving chronic pain and high-risk coexisting conditions.

The material covered differences between buprenorphine and full opioid agonists, identification of candidates for buprenorphine and initiation and management for chronic pain. Students delivered nine presentations over two months that each lasted 20 to 25 minutes.

Participants included inpatient and outpatient physicians, pharmacists and nurse practitioners. Pain clinical pharmacists answered questions afterward.

Researchers did a comparison of anonymous, voluntary questionnaires completed immediately before and after each session. Depending on the question, 102 to 105 paired responses were available.

Clinician perceptions and knowledge were measured in the project. The authors said future evaluation could examine pharmacy consultations and prescribing patterns.

Limitations included subjective survey responses, virtual presentations that made engagement harder to assess, different presenters and responses concentrated at one site.

The Importance of Buprenorphine Knowledge

Buprenorphine is a partial opioid agonist with high binding affinity. The article describes its analgesic effects and its lower potential for respiratory depression, opioid-induced constipation and euphoria compared with full opioid agonists.

It is available in several forms, but the FDA has approved buccal films, transdermal patches and injections for pain management.

The VA and Department of Defense consider buprenorphine a preferred agent when opioids are required for long-term chronic pain treatment, according to the report. Typical doses for chronic pain are smaller than those used for opioid use disorder.

Chronic pain, physical dependence and opioid use disorder can overlap, but they are not interchangeable diagnoses. This distinction is central to safe care. A patient taking long-term opioids as prescribed may need a carefully planned medication transition for pain, while a patient with OUD may need medication-assisted treatment and a broader addiction care plan.

Relevance to Medical Detox and Opioid Transitions

Medical detox programs typically encounter patients with pain. Individuals may also be experiencing opioid dependence and other health conditions.

The VA project does not test a detox protocol. Its educational topics overlap with skills needed during assessment and medication transitions.

Buprenorphine’s high receptor affinity means timing and dose selection matter when a person is moving from a full opioid agonist.

An inappropriate transition can contribute to precipitated withdrawal, and untreated pain can complicate stabilization.

Prescribers need to review the current medication, dose, timing, physical dependence and treatment goal.

The report notes that prescribing buprenorphine no longer requires an X-waiver. Prescribers still need an active Drug Enforcement Administration license.

Removing the waiver did not remove the need for clinical training. Pharmacy collaboration can help teams interpret guidelines, screen candidates, and develop consistent follow-up.

Patients should not attempt to switch opioids or stop long-term medication on their own. A clinician can assess withdrawal risk, pain control, other health conditions and medications before recommending a transition.

Finding Medical Detox Support

Detox.com lists medical detox and drug detox programs by location, including Indiana options. When contacting a program, ask whether clinicians evaluate chronic pain and opioid use disorder separately.

You should also ask if buprenorphine is available and how the team coordinates care after withdrawal stabilization. Call 800-996-6135Sponsored to get more information about your treatment options.