Giving Compass' Take:
- A recent study from AMA Network Open found that higher doses of buprenorphine treatment for opioid addiction might help more compared to lower doses.
- What are the access issues for treatment plans for opioid addiction?
- Learn more about the research on preventing addiction.
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People with opioid use disorder who received a lower dose of buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to new research.
The study, published 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.
Among patients who started buprenorphine treatment for opioid use disorder, 59% of those prescribed a 16-milligram daily dose and 53% of those prescribed a higher 24-milligram dose discontinued treatment within 180 days. The US Food and Drug Administration recommends a target daily dose of 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 note.
“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, a professor of epidemiology and emergency medicine at Brown University.
“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.”
Medications for opioid use disorder such as buprenorphine can safely and effectively support reduction in opioid use and overdose as well as recovery by decreasing opioid cravings and easing withdrawal symptoms, the researchers say.
Their findings build upon accumulating evidence of the safety and efficacy of higher doses of buprenorphine: Studies have shown that more than 16 milligrams of buprenorphine is safe and well tolerated in people with opioid use disorder in emergency department and outpatient treatment settings.
In 2021, of nearly 107,000 overdose deaths reported, more than 70,000 were primarily due to fentanyl, a synthetic opioid that is approximately 50 times stronger than heroin. The ubiquity of fentanyl in the drug supply and resulting overdose death rate increase have raised questions about whether existing dosing guidelines for buprenorphine should be modified to better address the unique challenges posed by such a potent opioid.
Read the full article about opioid addiction by Corrie Pikul at Futurity.