When a patch is placed, reliable analgesia does not occur until 12 to Transdermal buprenorphine (Butrans®) is another product available
24 hours; therefore, an equivalent opioid should be used in the first to provide systemic analgesia for patients with moderate to severe
12 hours to prevent the patient from suffering unnecessarily. Manu- chronic pain. It is available in 5-, 10-, and 20-mcg/hour patches that
facturers’ guidelines for conversion to and from oral morphine are can be worn for 7 days. The application site should be on the trunk
considered very conservative in converting to TDF and are not de- and rotated (not reused for 21 days). For opioid-naïve patients and
signed for converting from TDF to oral morphine. A more clinically those using less than 30-mg oral morphine equivalents, the 5-mcg/
relevant equivalent dose can be determined using this conversion: hour patch should always be the starting dose. If the patient is tolerant
1 mcg/hour TDF is approximately equivalent to 2 mg oral morphine to 30- to 80-mg oral morphine equivalents, then the 10-mcg/hour
per day. Therefore if the patient was taking a long-acting oral prod- patch may be started after titrating the patient down to 30 mg of oral
uct such as MS Contin 45 mg PO twice daily, a 50-mcg/hour TDF morphine per ^K