Buprenorphine at higher doses may be more effective in treating opioid dependence
September 25, 2024
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Press release
Wednesday, September 25, 2024
An NIH-funded analysis suggests that higher doses of buprenorphine are associated with lower future rates of behavioral health-related emergency department and inpatient treatment visits.
Adults with opioid use disorder who take a higher dose of buprenorphine daily to treat opioid dependence may be at reduced risk of requiring behavioral health services (such as mental health or substance abuse disorders) in the future, according to an analysis from the National Institutes of Health. This study suggests that higher doses of buprenorphine may help manage opioid use disorder. It may also be relevant to improving treatment for people who abuse fentanyl.
The researchers looked at insurance claims data from more than 35,000 patients who were diagnosed with opioid dependence disorder between 2016 and 2020 and started buprenorphine treatment. The researchers found that 12.5 percent of people starting buprenorphine treatment had a behavioral emergency room or hospital visit during the study period. The researchers adjusted for demographics, medical history, and other data to determine how long it took people taking different doses of buprenorphine before they needed emergency care or were hospitalized.
According to FDA labeling, buprenorphine should be taken at a dose of 16 mg per day. Researchers found that patients taking higher doses (>16-24 mg) of buprenorphine were 20% more likely to need a follow-up emergency department or hospital visit for behavioral health reasons in the first year after treatment than those taking a daily dose between 8 and 16 mg. Daily doses greater than 24 mg of buprenorphine took 50% longer to reach an emergency department or hospital for behavioral health reasons in the first year after treatment compared to those taking >8-16 mg.
Nora D. Volkow, MD, is director of the National Institute on Drug Abuse at the NIH. These findings provide further confirmation that high doses of buprenorphine can have a positive impact on the health of people with opioid addiction.
Nearly 70% of all overdoses reported in 2022 were due to fentanyl. This synthetic opioid is 50 times more potent than heroin. Given the prevalence of fentanyl and associated overdose deaths, questions have been raised about the need to change buprenorphine dosing recommendations to address the challenges posed by a potent opioid. Increased doses of buprenorphine may be necessary to manage the more severe withdrawal symptoms, cravings, and tolerance associated with fentanyl.
Bradley D. Stein, MD, is a co-author of the study and director of the RAND-USC Schaeffer Opioid Policy Tools and Information Center. He said preventing or delaying the need for urgent and intensive health care for people with opioid use disorder has a significant benefit to their health and recovery. As we gather more data from multiple studies, it appears that higher doses of buprenorphine may improve treatment, especially in an era of widespread fentanyl. Fatal and nonfatal overdoses are still unacceptable.
They also stress the importance of addressing barriers that prevent patients from receiving higher doses of medications, including state laws and insurance policies. It would also be helpful to review guidelines that block higher doses, as they could limit access to potentially life-saving treatments for patients at risk of overdose or relapse.
The data that was used for the study came from a commercial insurer, but did not include people who were uninsured or had Medicaid, Medicare fee-for-service, etc. Additionally, 75 % of the people analyzed were not Hispanic. Further research is needed to examine the effects of high doses of buprenorphine on more diverse groups, such as those with different insurance coverage or in different clinical settings. The authors also note that future studies should examine other outcomes, such as the long-term effects of high doses of buprenorphine and overall health outcomes using similar data.
This study adds to the growing body of evidence that higher doses are safe and effective. More than 16 mg of buprenorphine was shown to be effective. People are generally well tolerated and safe People with opioid addiction disorders are treated in outpatient and emergency departments. Higher doses of buprenorphine are associated with better retention in treatment For opioid abuse disorders.
The NIH's NIDA funded this study and it was published in JAMA Network Open. The study data were drawn from a large insurer's commercial claims database, which included Medicare Advantage.
Help is available for anyone in need. You can call or text 988Chat on 988lifeline.org. Visit this page to learn more about how you can get help for mental health issues or drug and alcohol abuse.FindSupport.gov . You can use the direct link to find a provider or treatment center.FindTreatment.govCall800-662-HELP (4357).
The National Institute on Drug Abuse: NIDA is part of the National Institutes of Health of the U.S. Department of Health and Human Services. NIDA is responsible for the majority of the world's research on substance abuse and its health effects. The Institute offers a broad range of programs that aim to improve policy, advance substance abuse research, and inform practice. Visit NIDA for more information about its programs and services. www.nida.nih.gov.
The National Institutes of Health: The NIH is the medical research agency of the U.S. Department of Health and Human Services. It includes 27 institutes and centers. The NIH, the nation's medical research agency, is the primary federal agency that conducts and supports basic, translational, clinical, and other types of medical research. It also studies the causes, treatments, and cures of common and rare diseases. Visit the NIH for more information about its programs and services. www.nih.gov.
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