Higher buprenorphine doses associated with improved retention in treatment for opioid use disorder

Sept. 19, 2023
NIH-funded study suggests need to reevaluate opioid addiction treatment recommendations in the era of fentanyl.

Individuals with opioid use disorder who were prescribed a lower buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to a study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became widely available. The study, published in JAMA Network Open, was supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and conducted by researchers at Brown University, Providence, Rhode Island; NIDA and the Rhode Island Department of Health.

Among patients newly initiating buprenorphine treatment for opioid use disorder, 59% of those prescribed the target daily dose of 16 milligrams recommended by the U.S. Food and Drug Administration and 53% of those prescribed the higher 24 mg daily dose discontinued treatment within 180 days. A statistical analysis that allowed for multivariable comparison of these two dose groups showed patients prescribed the recommended dose (16 mg) were significantly more likely to discontinue treatment over 180 days compared to those prescribed 24 mg.

In this study, researchers retrospectively examined data from a statewide population of 6,499 Rhode Island residents initiating buprenorphine as part of treatment for opioid use disorder from 2016 to 2020, a period of fentanyl emergence and predominance. The goal was to estimate the association between patients’ daily buprenorphine dose and retention in treatment over 180 days, a time frame which aligns with the minimum treatment period considered by the U.S. Centers for Medicare and Medicaid Services to measure treatment continuity for opioid use disorder.

Most patients were aged 25 to 44 years, were male, and had private or Medicaid insurance. At initiation of buprenorphine treatment, approximately 21% (1,343 patients) were prescribed 8 mg, 50% (3,264 patients) 16 mg, and 10% (668 patients) 24 mg. Those prescribed more than 24 mg were unable to be analyzed due to the small number (0.2%, or 15 patients) prescribed such doses during the study period.

Patients prescribed a 24 mg dose of buprenorphine were retained in treatment for a longer period than those prescribed the recommended target maintenance dose of 16 mg. A statistical analysis showed the latter group was 20% more likely to discontinue treatment than those prescribed 24 mg.

NIH release

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