In the era of fentanyl, patients taking higher buprenorphine doses are more likely to continue treatment.
People with opioid use disorder who received a lower buprenorphine dose were 20 percent more likely to discontinue treatment than those on a higher dose, according to new research.
The study, published today in JAMA Network Open, focused on patients prescribed buprenorphine in Rhode Island from 2016 to 2020—a time period in which the highly potent prescription opioid fentanyl began to increase drug overdoses and deaths. It was conducted by researchers at Brown University, the National Institute on Drug Abuse, and the Rhode Island Department of Health.
Among patients who started buprenorphine treatment for opioid use disorder, 59 percent of those prescribed a 16-milligram daily dose and 53 percent of those prescribed a higher 24-milligram dose discontinued treatment within 180 days. The target daily dose recommended by the US Food and Drug Administration is 16 milligrams per day. A multivariable comparison of these two study groups showed patients prescribed the recommended dose were significantly more likely to discontinue treatment over 180 days compared to those prescribed 24 mg.
The guidance for the target daily dose was established prior to the emergence of fentanyl in the illicit drug supply, and the guidance has not been formally reevaluated since fentanyl became widely available, the researchers noted.
“Medications for opioid use disorder, such as buprenorphine, are life-saving, but only if people start them and stay on them,” says study author Francesca Beaudoin, MD, PhD, a professor of epidemiology and of emergency medicine at Brown. “These medications have been around for a long time, but fentanyl has not. It is imperative that we reevaluate and update treatment guidelines to account for today’s opioid crisis—otherwise, we are putting lives at risk. This study indicates that people who are prescribed higher doses of buprenorphine tend to stay on it longer.”