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Introduction: Opioid use disorder is a chronic illness with significant morbidity and mortality. Opioid agonists, like buprenorphine, are commonly used to prevent relapse. Recent changes in buprenorphine legislation are expected to increase prescription and guidelines recommend its continuation during the perioperative period for many patients. However, buprenorphine's strong affinity for mu receptors can complicate perioperative pain management, requiring high doses of analgesics and increasing risks like respiratory depression. A newly FDA-approved sublingual sufentanil system, with higher mu receptor affinity, may offer a solution., Case Presentation: A series of three cases with patients undergoing outpatient surgery procedures while continuing buprenorphine treatment are presented., Management and Outcomes: Sublingual sufentanil was effective in lowering pain with no adverse effects for the buprenorphine patients undergoing surgery with general anesthesia without a missed dose., Conclusion: Further research is needed to make conclusive remarks on the efficacy of this treatment, but the quick onset and effective treatment make this route worthwhile to consider., Competing Interests: All authors except Dr. Naum Shaparin and Dr. Karina Gritsenko report no disclosures. Dr. Naum Shaparin reports receiving research funding from AcelRx Pharmaceuticals, Averitas Pharma, and Heron Therapeutics. Dr. Karina Gritsenko reports being a consultant for Pacira Biosciences and Grunenthal Pharmaceuticals.