Researchers at Johns Hopkins Hospital reported that patients treated with buprenorphine for opioid use disorder show surprisingly significant improvements in adhering to medications for other chronic unrelated conditions.

Published in the journal Medical Care (2019;57[9]:667-672), the population-based, retrospective study reviewed medical records for more than 12,000 patients with a diagnosis of opioid use disorder (OUD) who were given buprenorphine, a partial opioid agonist widely used to treat OUD. Expanded use of buprenorphine is linked with the national epidemic of opioid misuse. In 2016, approximately 700,000 Americans filled buprenorphine prescriptions—more than double the number 10 years earlier. However, a recent study found disparities in access to the medication. The rate of Medicaid-covered prescriptions for buprenorphine was much lower in states that did not expand their Medicaid programs in accordance with the Affordable Care Act.

According to the authors, this is the first study assessing the effectiveness of an opioid addiction medication for adherence to therapies for common and costly psychiatric and cardiovascular diseases. “When addiction is treated, individuals may experience improved organization and self-efficacy that could lead to better adherence to antidepressants, antiepileptics and other medications for chronic diseases,” the authors wrote.

Approximately half of the patients studied had five or fewer chronic conditions, 25% had six to 10, and the remainder had more than 10. About 5,500 patients were in at least one of five therapeutic cohorts representing a different therapeutic class: antilipids, antipsychotics, antiepileptics, antidiabetics and antidepressants. Using buprenorphine was associated with increased probability of medication compliance in all five therapeutic areas examined, ranging from a 4% increase for antiepileptics to 8% for antidepressants.

“Our findings are of both clinical and economic importance because there is a large and growing population with OUD, and a high burden of comorbid chronic somatic and psychiatric diseases in this population,” said co-author G. Caleb Alexander, MD, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health Center for Drug Safety and Effectiveness, in Baltimore. He added the strongest association was between buprenorphine initiation and treatment with antidepressants, which may be attributable to greater experience among buprenorphine prescribers with using antidepressants and recognition of serious risks posed by untreated depression.

“Our findings suggest that initiating buprenorphine may be associated with improvements in adherence for other conditions, such as depression, that are both common and costly among those with OUD,” Dr. Alexander said.

“When someone with OUD visits a doctor’s office to get a prescription for buprenorphine, the examination might reveal other chronic conditions, including mental health disorders. So, you go to the doctor for one medication and leave with prescriptions for others,” Dr. Alexander said.

When addiction is treated with buprenorphine, individuals may become more self-confident and responsible and willing to make needed behavioral and lifestyle changes, he added. Access to buprenorphine requires visits to medical practitioners, so the increased adherence to antidepressants and other medications may result from increased and improved access to comprehensive care for addiction.

—Chuck Weber