opioids

Most Who Receive Buprenorphine Discontinue It Quickly

The majority of patients with opioid use disorder (OUD) who receive buprenorphine for their symptoms likely discontinue the medication within 6 months of receipt, according to new findings.

 

A number of factors—including race/ethnicity, age, gender, comorbidities, and initial buprenorphine dose—were found to impact these rates.

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“For Medicaid beneficiaries with OUD treated with buprenorphine, there is a need to implement treatment models that more effectively address barriers to treatment retention,” the researchers wrote. “These barriers are particularly challenging for minorities, younger individuals, and those with additional substance use disorders,” they added.

 

Their findings arose from a study of 2013-2015 insurance claims data from the MarketScan multi-state Medicaid database. The study sample included 17,329 individuals aged 18 to 64 years with a diagnosis of OUD in the 6 months prior to buprenorphine initiation.

 

Cox proportional hazards regression was used to estimate participants’ risk of treatment discontinuation (defined as more than 30 days without buprenorphine supply). Logistic regression was implemented to estimate the likelihood of persistent treatment for a minimum of 180 days.

 

Results of the study indicated that 28.4% (n = 4928) of patients in the sample had discontinued buprenorphine within the first month of treatment, and 64.6% (n = 11,189) had discontinued it before 180 days.

 

In the proportional hazards model, hazard ratios (HRs) during the 6-month baseline period were:

 

  • 1.72 for a lower initial buprenorphine dose (4 mg or less)
  • 1.19 for male sex
  • 1.34 for younger age
  • 1.31 for black race/ethnicity
  • 1.24 for Hispanic race/ethnicity
  • 1.09 for other minority races/ethnicities
  • 1.21 for capitated insurance
  • 1.07 for comorbid alcohol use disorder
  • 1.14 for substance use disorders involving non-opioid drugs
  • 1.06 for hepatitis C
  • 1.20 for opioid overdose history
  • 1.22 for any inpatient care

 

Similarly, these same risk factors pointed towards a significantly lower likelihood of treatment retention for at least 180 days in logistic models, the researchers noted.

 

—Christina Vogt

 

Reference:

Samples H, Williams AR, Olfson M, Crystal S. Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees. J Substance Abuse Treatment. 2018;95:9-17. https://doi.org/10.1016/j.jsat.2018.09.001