Summary: Opioid drugs, which belong to a broad group of substances that act on the central nervous system, play a key role in the pharmacotherapy of pain. Their mechanism of action involves binding to opioid receptors located in peripheral neurons, brain, spinal cord and other non-neuronal tissues, leading to a reduction in nervous system sensitivity, pain perception and emotional response to pain. These receptors – mi (MOR), delta (DOR) and kappa (KOR) – are involved in the regulation not only of pain, but also of mood, respiratory, immune, endocrine and gastrointestinal function, explaining the wide range of potential adverse effects. In clinical practice, individual opioid selection is based on a number of factors related to the patient, the drug and the nature of the pain itself, including: the underlying disease causing the pain; co-morbidities – renal function, liver function, other medications used by the patient; risk of adverse reactions and interactions induced by the opioid, short- and long-term safety; risk of drug dependence; patient's preference for route of opioid administration; severity and mechanism of pain, as well as the nature of the pain. Among the various pain treatments, opioids hold a unique place due to their efficacy. They are the subject of extensive scientific and social debate, and within this debate, buprenorphine occupies an important place due to its safety profile compared to other opioid drugs. This includes a ceiling effect on respiratory depression, no accumulation in renal failure, anti-hyperalgesic effect, lower risk of tachyphylaxis, abuse, immunosuppression and effects on sexual function. In the elderly, the advantage is a lower risk of inducing constipation and less impact on cognitive function.