Buprenorphine is a strong opioid used either sublingually for the treatment of opioid dependence, or transdermally for the relief of chronic pain.

Transdermal buprenorphine patches can be broadly categorised as either high or low strength.

• Lower strength products deliver between 5 and 20mcg/hour of buprenorphine and are licensed for the treatment of moderate intensity pain that is non-malignant in origin. These lower strength patches are applied every 7 days.
• Higher strength patches deliver 35, 52.5 or 70mcg/hour and are licensed for the treatment of moderate to severe cancer pain or severe pain that does not respond to non-opioid analgesics. These patches are applied every 3 or 4 days dependent upon the brand supplied.

Transdermal buprenorphine is not suitable for the relief of acute pain or for use in patients where a rapid change in analgesic dose may be required.

Transdermal buprenorphine is 70-115 times more potent than oral morphine[1]. This high potency along with the wide range of products with differing strengths, administration schedules and duration of action significantly increases the risk of patient safety incidents.

Buprenorphine related patient safety incidents can be caused by prescribing, supply or administration errors including:

• Initiating the patient on either too high or low a dose of transdermal buprenorphine.
• Incorrect conversion from oral opiates.
• Failure to remove the old patch when applying a new patch.
• Changing a buprenorphine patch earlier or later than the licensed dose schedule.
• Increased release of buprenorphine due to excessive heat exposure either
  • internal i.e. fever.
  • external e.g. electric blanket, heat pad or hot water bottle.
• Administering fentanyl patches instead of buprenorphine patches.

 Risks associated with the use of transdermal buprenorphine can be minimised by:

• Confirming the dose prescribed is suitable for the individual patient whether they are opiate naïve or being transferred from another opiate.
• Being aware of the range of transdermal buprenorphine products available, their strengths and licensed dose i.e. frequency of patch application.
• Including the dose rate and frequency of patch replacement on the dispensing label.
• Effectively counselling the patient, including the frequency of application of new patches and the need to remove the existing patch before applying a new patch.
• Encouraging patients to keep records of when they remove old patches and apply new ones.
• Providing care homes with a record of topical administration to record application of patches and the application site.

A topical record of administration is available to download from NumarkNet. https://www.numarknet.com/download/detail/789?ref=side

• Ensuring dispensing labels do not obscure important patient information on the product packaging.

The use of transdermal buprenorphine is increasing in the UK as are the number of products, range of doses and duration of action available, this directly increases the potential for patient safety incidents. Risks can be reduced by effective clinical checks within the pharmacy and appropriate patient education or counselling.