SEPTEMBER 25, 2023
A new study funded by the National Institutes of Health highlights the importance of proper dosing for opioid use disorder (OUD) treatment, finding that patients taking lower doses of the OUD drug buprenorphine were 20% more likely to discontinue treatment than those prescribed higher doses.
The study (JAMA Netw Open 2023;6[9]:e2334540) was conducted by researchers at Brown University, in Providence, R.I., the National Institute on Drug Abuse (NIDA), and the Rhode Island Department of
A new study funded by the National Institutes of Health highlights the importance of proper dosing for opioid use disorder (OUD) treatment, finding that patients taking lower doses of the OUD drug buprenorphine were 20% more likely to discontinue treatment than those prescribed higher doses.
The study (JAMA Netw Open 2023;6[9]:e2334540) was conducted by researchers at Brown University, in Providence, R.I., the National Institute on Drug Abuse (NIDA), and the Rhode Island Department of Health from 2016 to 2020. This was a time when illicit fentanyl was becoming widely available in the area.
Current FDA-approved buprenorphine labeling allows for maintenance doses ranging from 4 to 24 mg, with a recommended target dose of 16 mg per day for most patients. Recommended doses depend on a person’s needs and response to the medication, and can vary widely.
In this study, researchers retrospectively examined data from a statewide population of 6,499 Rhode Island residents initiating buprenorphine as part of treatment for OUD. The goal was to estimate the association between patients’ daily buprenorphine dose and retention in treatment over 180 days, a time frame that aligns with the minimum treatment period considered by the Centers for Medicare & Medicaid Services to measure treatment continuity for OUD.
Most patients were aged 25 to 44 years, were male, and had private or Medicaid insurance. At the start 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 not analyzed due to the small number (0.2%, or 15 patients) prescribed such doses during the study period.
Analysis showed that patients prescribed the recommended dose of 16 mg were significantly more likely to discontinue treatment over 180 days than those prescribed 24 mg (59% vs. 53%).
“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, MD, in a press statement. “If science continues to demonstrate that a higher dosage of buprenorphine increases treatment retention, we must reevaluate clinical guidelines to optimize treatment and help people achieve recovery.”
“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, MD, an 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.”
Further research will include a prospective randomized clinical trial to assess the efficacy of daily buprenorphine doses up to 24 mg in improving treatment retention and reducing the risk for overdose and death, as well as factors affecting retention, including clinician prescribing practices, patient sociodemographics and life circumstances.
Based on a press release from JAMA Network Open.
