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Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort
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8 01 2021
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Source: Drug Alcohol Depend. 225:108764
[PDF-701.80 KB]
Details:
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Alternative Title:Drug Alcohol Depend
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Personal Author:
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Description:Background and Aims:
While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort.
Setting:
United States
Participants:
Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone.
Measurements:
Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose.
Findings:
We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%−60%) of extended-release buprenorphine, 64% (95% CI 61%−69%) of extended-release naltrexone, 34% (95% CI 33%−35%) of mucosal buprenorphine, and 58% (95% CI 54%−62%) of methadone initiators had discontinued treatment.
Conclusions:
Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.
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Source:
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Pubmed ID:34051547
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Pubmed Central ID:PMC8488795
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Volume:225
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