Positives

• In a microdialysis study, patients dosed with buprenorphine showed essentially no histamine or tryptase release, unlike codeine and meperidine, supporting its use when MCAS patients need an opioid PubMed.
  
  
• A chronic pain patient on the Butrans buprenorphine patch reported it had totally turned them around after years of inadequate control on other opioids Drugs.com.
  
  

Negatives

• A reviewer found the buprenorphine patch only knocked their pain from a 7 down to a 5, leaving meaningful breakthrough pain Drugs.com.
  
  
• Across 522 chronic pain reviews on Drugs.com, buprenorphine averaged only 5.4/10, with 27% of users reporting a negative experience Drugs.com.
  
  

Hurdles & Side Effects

• Patients reported the buprenorphine patch had adhesion problems, frequently lifting off and sometimes falling off without their noticing, requiring extra tape Drugs.com.
  
  
• MCAS patients still need to vet each manufacturer's excipients because the same buprenorphine product made with different dyes or fillers can provoke very different reactions TMS Society.