A recent analysis indicates that higher doses of buprenorphine, a medication used to treat opioid use disorder, may lead to better outcomes for patients, potentially reducing the need for emergency department visits and inpatient services related to behavioral health. The study, funded by the National Institutes of Health (NIH), suggests that increasing buprenorphine dosages could be a more effective strategy for managing opioid use disorder, especially in the context of the ongoing fentanyl crisis.
The research team analyzed insurance claims data from over 35,000 individuals diagnosed with opioid use disorder who initiated buprenorphine treatment between 2016 and 2021. The study revealed that 12.5% of these individuals required emergency department or inpatient care for behavioral health issues during the study period. After adjusting for demographic and medical history, the researchers examined the time elapsed before patients on different buprenorphine doses needed emergency or inpatient care.
The FDA's recommended target dose for buprenorphine is 16 mg per day. The study found that patients receiving higher daily doses (>16 to 24 mg) experienced a 20% longer period before requiring emergency department or inpatient care for behavioral health within the first year of treatment, compared to those receiving >8 to 16 mg per day. Furthermore, patients on daily doses exceeding 24 mg of buprenorphine had a 50% longer interval before needing subsequent emergency or inpatient care within the first year, compared to those receiving >8 to 16 mg daily.
Expert Commentary
"As the overdose crisis evolves, particularly with the rise of fentanyl, it is crucial to investigate how to best adapt and deliver the lifesaving and evidence-based treatments for opioid use disorder that we have available," said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). "The findings add to the growing evidence that higher doses of buprenorphine may have meaningful health impacts for people with opioid use disorder."
The Impact of Fentanyl
In 2022, nearly 70% of the approximately 108,000 overdose deaths in the U.S. were primarily attributed to fentanyl, a synthetic opioid roughly 50 times stronger than heroin. The prevalence of fentanyl has prompted questions regarding the adequacy of existing buprenorphine dosing guidelines. Higher doses of buprenorphine may be necessary to effectively manage the more severe withdrawal symptoms, cravings, and tolerance associated with fentanyl use.
Addressing Barriers to Access
"Preventing or delaying the need for high-intensity, urgent health care among people with opioid use disorder has tremendous benefits on health and recovery," said Bradley D. Stein, M.D., Ph.D., a study co-author and director of the RAND-USC Schaeffer Opioid Policy Tools and Information Center. He also noted that addressing barriers to accessing higher doses, such as state laws and insurance policies, is crucial for ensuring that all patients receive effective care.
Study Limitations
The study's data were derived from a single commercial insurance company, excluding uninsured individuals and those with Medicaid or fee-for-service Medicare coverage. Additionally, the sample was predominantly (75%) non-Hispanic white. Further research is needed to assess the effects of higher buprenorphine doses in more diverse populations and different clinical settings. Future studies should also investigate long-term effects on treatment retention and overall health outcomes.
Prior Research
These findings are consistent with previous research demonstrating the safety and efficacy of buprenorphine doses exceeding 16 mg in opioid use disorder treatment. Studies have indicated that higher buprenorphine doses are associated with improved retention in treatment.
The study was published in JAMA Network Open and funded by NIH’s NIDA. The data analyzed were sourced from a large insurer’s database of commercial claims, including Medicare Advantage claims.
