Higher Buprenorphine Doses Linked to Better Retention in Opioid Use Disorder Treatment
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NIH-Funded Study Highlights Need to Update Treatment Guidelines Amid Fentanyl Crisis
Individuals with opioid use disorder who were prescribed lower doses of buprenorphine were found to be 20% more likely to discontinue treatment compared to those on higher doses, according to a recent study. This research, conducted between 2016 and 2020 in Rhode Island as fentanyl became widely available, highlights the critical need to reevaluate opioid addiction treatment recommendations. Supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), and carried out by researchers at Brown University, this study was published in JAMA Network Open.
Key Findings
The study analyzed data from patients newly initiating buprenorphine treatment for opioid use disorder. It revealed that 59% of patients prescribed the FDA-recommended target dose of 16 milligrams daily and 53% of those prescribed a higher dose of 24 mg discontinued treatment within 180 days. Statistical analysis showed that patients on the 16 mg dose were significantly more likely to stop treatment compared to those on the 24 mg dose.
Buprenorphine is a medication that effectively supports the reduction of opioid use and overdose risk by decreasing cravings and easing withdrawal symptoms. Accumulating evidence demonstrates that higher doses of buprenorphine, exceeding 16 mg, are both safe and well-tolerated in various treatment settings.
Implications for Treatment Guidelines
“Effective treatment can save lives, but our proven treatments for opioid use disorders must evolve to match the challenges posed by the fentanyl crisis,” said NIDA Director, Nora Volkow, M.D. “If science continues to demonstrate that a higher dosage of buprenorphine increases treatment retention, we must re-evaluate clinical guidelines to optimize treatment and help people achieve recovery.”
In 2021, out of nearly 107,000 reported overdose deaths, over 70,000 were primarily due to fentanyl, a synthetic opioid approximately 50 times stronger than heroin. The widespread presence of fentanyl in the drug supply has significantly increased overdose deaths, prompting questions about whether current buprenorphine dosing guidelines should be updated to address this potent opioid more effectively.
Study Details
Researchers examined data from 6,499 Rhode Island residents who initiated buprenorphine treatment between 2016 and 2020, a period marked by the emergence and predominance of fentanyl. Most patients were aged 25 to 44 years, male, and had private or Medicaid insurance. Upon starting buprenorphine treatment, approximately 21% were prescribed 8 mg, 50% were prescribed 16 mg, and 10% were prescribed 24 mg. Only 0.2% were prescribed doses higher than 24 mg, making it challenging to analyze this group.
The study found that patients on a 24 mg dose had better treatment retention than those on the 16 mg dose. Statistical analysis showed that those on the recommended 16 mg dose were 20% more likely to discontinue treatment compared to those on 24 mg.
Moving Forward
“The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl. Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose – up to 24 mg – may help improve treatment retention for these individuals,” said Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the principal investigators of the study. “We have a responsibility to set patients up for success.”
Future research aims to conduct a prospective randomized clinical trial to assess the impact of daily buprenorphine doses up to 24 mg on improving treatment retention and reducing overdose risk. This trial will also explore other factors influencing treatment retention, such as clinician prescribing practices and patient socio-demographics. Findings from this research could help inform updates to opioid use disorder treatment standards.
For more information on substance and mental health treatment programs, call the free and confidential National Helpline at 1-800-662-HELP (4357) or visit FindTreatment.gov.
References
Chambers, L.C., et al. Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.34540 (2023)
About the National Institute on Drug Abuse (NIDA): NIDA supports most of the world’s research on the health aspects of drug use and addiction, aiming to improve policy, practice, and advance addiction science. For more information, visit nida.nih.gov.
About the National Institutes of Health (NIH): NIH is the primary federal agency for conducting and supporting medical research, investigating causes, treatments, and cures for common and rare diseases. For more information, visit nih.gov.
About Substance Use Disorders: In 2021, over 46 million people in the U.S. had at least one substance use disorder. Substance use disorders are chronic, treatable conditions, and using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide for more information.