# Iatrogenic physiologic opioid dependence masquerading as recurrent acute pancreatitis flares: case series

## TL;DR

Two patients with recurring pancreatitis flares were found to have opioid dependence, which was managed with buprenorphine, reducing hospitalizations.

## Contribution

This case series highlights iatrogenic opioid dependence in pancreatitis patients and the effectiveness of buprenorphine in managing it.

## Key findings

- Two patients with recurrent pancreatitis developed iatrogenic opioid dependence after frequent opioid prescriptions.
- Both stabilized and remained hospitalization-free for over a year after starting buprenorphine.
- Buprenorphine can provide safer pain control and treat opioid dependence in such patients.

## Abstract

Patients with recurrent acute flares of pancreatitis—especially those receiving frequent opioid treatment for pain—can develop physiologic dependence to opioids. This can complicate the clinical picture, making it difficult to distinguish between true pancreatitis flares and opioid withdrawal presenting with similar symptoms. We describe two cases of patients admitted recurrently for pancreatitis: a 24-year-old Haitian male with alcohol use disorder, and a 37-year-old Indian female with hypertriglyceridemia. Both developed iatrogenic physiologic opioid dependence after frequent hospitalizations and opioid prescriptions. Both patients stabilized after initiation of buprenorphine, remaining in care and hospitalization-free for over a year. These cases illustrate the importance of identifying and treating the underlying etiology of abdominal pain, judiciously prescribing opioids to treat pancreatitis flares, and having a low threshold for considering iatrogenic physiologic opioid dependence in patients evaluated for recurrent pancreatitis. They also highlight the potential role that buprenorphine can play to mitigate recurrent admissions by providing safer pain control and treatment for physiologic opioid dependence.