Rhode Island study finds opioid use disorder patients who reduce their dose of buprenorphine have a 20% higher dropout rate, suggesting dosing guidelines need to be reevaluated amid fentanyl crisis .
NIH-funded research suggests a need to reevaluate opioid addiction treatment recommendations in the era of opioid addiction. Fentanyl.
People with opioid use disorder who were prescribed low doses of buprenorphine were 20% more likely to discontinue treatment than those on higher doses. That’s according to a study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became widely available. This study was published on September 18th. JAMA network open. This was supported by the National Institute on Drug Abuse (NIDA). National Institutes of Health, conducted by researchers at Brown University in Providence, Rhode Island. NIDA and the Rhode Island Department of Health.
Recommended dose and patient response
Among patients newly starting buprenorphine treatment for opioid use disorder, 59% were prescribed the U.S. Food and Drug Administration (FDA) recommended target daily dose of 16 mg; 59% were prescribed the higher daily dose of 24 mg; 53% of patients stopped treatment within 180 days. day to day. Statistical analyzes that allowed for multivariate comparisons of these two dose groups showed that patients prescribed the recommended dose (16 mg) were less likely to discontinue treatment for more than 180 days compared to patients prescribed 24 mg. It was shown that the possibility of
Opioid use disorder treatments, such as buprenorphine, safely and effectively support the reduction and reversal of opioid use and overdose by reducing cravings for opioids and alleviating withdrawal symptoms. These findings build on accumulating evidence of the safety and efficacy of high doses of buprenorphine.Studies have shown that more than 16 mg of buprenorphine Safe and well tolerated by humans Patients with opioid use disorder in emergency departments and outpatient treatment settings.
The need for therapeutic advances amid the fentanyl crisis
“Effective treatment can save lives, but our proven treatments for opioid use disorder must evolve to meet the challenges posed by the fentanyl crisis,” said NIDA Director Nora. Dr. Volkow said: To maintain retention, clinical guidelines need to be re-evaluated to optimize treatment and help people recover. ”
Of the approximately 107,000 overdose deaths reported in 2021, more than 70,000 were primarily caused by fentanyl, a synthetic opioid about 50 times more potent than heroin. The ubiquity of fentanyl in the drug supply and the resulting increase in overdose death rates warrants modifications to existing dosing guidelines for buprenorphine to better address the unique challenges posed by such a powerful opioid. This raises questions about whether it should be done. Currently, the FDA-approved label states that maintenance doses should range from 4 mg to 24 mg, with a recommended target dose of 16 mg per day for most patients. Masu. Recommended doses for treatment also vary widely depending on individual needs and response to the drug.
Study parameters and results
The study retrospectively examined data on 6,499 Rhode Islanders across the state who started buprenorphine as part of their treatment for opioid use disorder between 2016 and 2020, when fentanyl emerged and became dominant. The goal was to estimate the association between patients’ daily buprenorphine dose and treatment retention over 180 days. This period is consistent with the minimum length of treatment considered by the U.S. Centers for Medicare and Medicaid Services to measure treatment continuity for opioid use disorder.
Most patients were 25 to 44 years old, male, and had private or Medicaid insurance. At the beginning of buprenorphine treatment, approximately 21% (1,343 patients) were prescribed 8 mg, 50% (3,264 patients) were prescribed 16 mg, and 10% (668 patients) were prescribed 24 mg. Patients prescribed doses greater than 24 mg could not be analyzed due to the small number (0.2%, or 15 patients) of those prescribed such doses during the study period.
Patients prescribed 24 mg of buprenorphine remained on treatment longer than those prescribed the recommended target maintenance dose of 16 mg. Statistical analysis showed that the latter group was 20% more likely to discontinue treatment than the group prescribed 24 mg.
“Currently recommended target doses for buprenorphine are based on research conducted before fentanyl was widely available. We are currently seeing people with high levels of tolerance and dependence to opioids, and the buprenorphine dose Our findings suggest that increasing the dose (up to 24 mg) may improve treatment retention in these populations,” said Associate Rachel Wightman, MD. Professor of Emergency Medicine and Epidemiology at Brown University Alpert School of Medicine and one of the study’s principal investigators. “We have a responsibility to help our patients succeed.”
Future research directions
To continue this research, scientists will conduct a prospective randomized clinical trial to evaluate the effectiveness of daily doses of buprenorphine up to 24 mg in improving treatment retention and reducing the risk of overdose and death. That’s what I’m aiming for. In this trial, researchers will also investigate the role of other factors that may be associated with treatment retention, such as clinicians’ prescribing practices and patients’ sociodemographic and living circumstances. The results of this trial could ultimately help inform updated standards of treatment for opioid use disorder.
References: “Buprenorphine Dosage and Time to Discontinuation in Patients with Opioid Use Disorder in the Fentanyl Era” Laura C. Chambers, Ph.D., MPH; Benjamin D. Hallowell, Ph.D., MPH. Andrew R. Zullo, Pharm.D. Taylor J. Paiva, MPH. Justin Burke, MD, MPH, MBA. Rachel Gaither, Bachelor of Science; Dr. Aidan J. Hampson. Francesca L. Beaudoin, MD, PhD and Rachel S. Wightman, MD, FACMT, September 18, 2023; JAMA network open.
DOI: 10.1001/jamanetworkopen.2023.34540
This research was funded by the National Institute on Drug Abuse, part of the National Institutes of Health, under award number UG3DA056880. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
