Acute Care Utilization Lower When Buprenorphine Doses Are Higher
US adults with opioid use disorder (OUD) who received buprenorphine at doses higher than recommended by the Food and Drug Administration (FDA) had significantly lower rates of urgent health care utilization than those whose doses were in line with FDA recommendations. Researchers published their findings online in JAMA Network Open.
“These results suggest that higher doses of buprenorphine are associated with lower acute care utilization and could provide benefits to patients, particularly those using fentanyl who might need these higher doses,” wrote corresponding author Bradley D. Stein, MD, PhD, of RAND, Pittsburgh, Pennsylvania, and study coauthors.
Related: Treatment Discontinuation Rates Lower With Methadone Than Buprenorphine/Naloxone
The study investigated links between higher buprenorphine doses (above 16 mg and 24 mg) and subsequent emergency department or inpatient service use among patients diagnosed with OUD. Researchers analyzed deidentified health data for the years 2016 and 2021 for adults who were dispensed a supply of buprenorphine for 14 days or longer.
The study included 35,451 patients with OUD who began buprenorphine treatment. Among them, 651 patients (1.8%) received a dose of more than 24 mg daily, 10,329 patients (29.1%) received a dose of more than 16 mg to 24 mg daily, 14,802 patients (42.9%) received a dose of more than 8 mg to 16 mg daily, and 9669 patients (27.3%) received a dose of 1 mg to 8 mg daily.
Overall, 12.5% of patients had an emergency department or inpatient visit for a behavioral health diagnosis, according to the study. Patients receiving doses higher than 24 mg and doses between 16 mg to 24 mg had longer times between initiation of the maximum buprenorphine dose and emergency department or inpatient use compared with patients receiving doses between 8 mg and 16 mg.
“Daily doses of more 8 mg to 16 mg are more common than higher doses, likely influenced to some extent by both state laws, insurance policies, and federal language regarding 16 mg as a target dose,” researchers wrote. “While there is increasing attention to the potential benefits of increasing access to buprenorphine through low-barrier and targeted programs to historically underserved populations …our findings contribute to the growing research regarding the potential benefits of higher buprenorphine doses, and suggest revisiting policies and guidelines that may serve as barriers to higher doses should also be part of these conversations.”
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