Which opioid is recommended for chronic pain in patients with a history of substance abuse due to its lower potential for dependency?

Buprenorphine is recommended for chronic pain management in patients with a history of substance abuse because it has a unique pharmacological profile that lowers the potential for opioid dependence. As a partial agonist at the mu-opioid receptor, buprenorphine provides pain relief while also minimizing the risk of euphoria and the reinforcing effects typically associated with full agonists like morphine and fentanyl. This mechanism helps reduce the likelihood of misuse among individuals with a prior history of substance abuse.

Additionally, buprenorphine has a "ceiling effect" at higher doses, which means that after a certain dose, increasing the dose does not result in increased effects. This characteristic further protects against the risk of overdose and dependence compared to full agonist opioids.

In contrast, opioids like morphine, fentanyl, and meperidine do not share these beneficial properties and carry a higher risk of leading to tolerance, dependence, and potential misuse, making them less suitable options for patients with a history of substance use disorder.