Buprenorphine vs. Opioid Dose Escalation Among Patients With Chronic Pain

Participants were recruited and enrolled at VACT West Haven, CT. Participants are aged 18 and older and have 3 months or more of continuous opioid therapy for chronic pain. Participants are actively prescribed 30-100mg of morphine equivalent opioid dose based on pharmacy records. Primary Care Providers will assent for patient participation. Inclusion Criteria: * Aged 18 and older * 3 months of continuous opioid therapy for chronic pain; * 30-100 mg morphine equivalent daily opioid dose based on pharmacy records of standing and as needed opioids prescribed. * 28 (out of 70) on the 7-item Brief Pain Inventory (BPI) functional interference subscale at screening * Numerical pain rating of 4 or greater (i.e., moderate pain or greater) at screening on the 11-point pain numerical rating scale (NRS) * Females must (a) be using birth control pills or depo provera injections, or have an intrauterine device; or (b) be post-menopausal, or (c) have undergone surgically sterilization. * Primary care provider's (PCP) assent for patient participation, ascertained via encrypted email or in-person query. Exclusion Criteria: * DSM-IV defined substance use disorder, except nicotine dependence. Participants known to using marijuana, including those who are apparently legally authorized to use marijuana by non-VHA providers, will be excluded since opioid dose escalation in regular marijuana users is contraindicated. * Opioid therapy for palliative care * Participation in another investigational pharmaceutical trial within 30 days of screening * Pregnancy or lactation * Recently decompensated medical illness necessitating inpatient hospitalization (past 30 days) * Transaminases (aspartate aminotransferase/alanine aminotransferase) greater than five times the upper limit of normal within 90 days of assessment phase * Not well-controlled psychiatric symptoms at the time of physician assessment, including suicidal ideation or untreated psychosis; or recently decompensated psychiatric illness necessitating inpatient hospitalization (past 30 days). * Use of a moderate to strong CYP3A4 inhibitor