Although the National Quality Forum recommends a minimum treatment duration of 6 months for buprenorphine, many patients discontinue within a few weeks or months of treatment initiation. In an effort to understand whether outcomes were better with longer term use of buprenorphine, Williams and colleagues1 looked at adverse outcomes of patients who had been on buprenorphine for at least six months.
The researchers undertook a retrospective longitudinal cohort analysis using a Medicaid claims database (2013-2017) of 12 million beneficiaries annually. The sample included adults aged 18 to 64 years who had received buprenorphine continuously for 180 days or longer (ie, 6 to 9 months, 9 to 12 months, 12 to 15 months, and 15 to 18 months). Primary adverse outcomes included emergency department visits, inpatient hospitalizations, opioid prescriptions, and drug overdose.
Patients who were on buprenorphine for 15 to 18 months had lower rates of emergency department visits, inpatient hospitalizations, and filling opioid prescription in the 6 months following discontinuations. However, use of acute care service and overdose were high for all treatment durations following buprenorphine discontinuation. Although rates of adverse outcomes remained high, the best outcomes were seen with treatment duration of 15 months on longer.
1. Williams AR, Samples H, Crystal S, Olfson M. Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder. Am J Psychiatry. 2020;177:117-124.