Prescribing decisions at buprenorphine treatment initiation: Do they matter for treatment discontinuation and adverse opioid-related events?

Abstract

INTRODUCTION\nBuprenorphine is a highly effective medication treatment for opioid use disorder (OUD) that can be prescribed in multiple treatment settings. Treatment retention, however, remains a challenge. In this study, we examined the association of days of supply as well as daily dosage of the initial buprenorphine prescription with treatment discontinuation and adverse opioid-related events following buprenorphine initiation.\n\n\nMETHODS\n2011 to 2015 Health Care Cost Institute commercial claims data were analyzed for individuals aged 18-64\u202fyears initiating buprenorphine treatment (N\u202f=\u202f17,158). Treatment discontinuation was defined as a gap of 30\u202fdays or more in buprenorphine use within 180\u202fdays of initiation. Adverse opioid-related events were defined as having at least one emergency department visit or inpatient admission involving opioid poisoning, dependence or abuse within 360\u202fdays of initiation. We conducted multivariate logistic regressions to estimate adjusted odds ratios of outcomes associated with daily dose (≤4\u202fmg vs. >4\u202fmg) and days of supply (≤7, 8-15, 16-27, or\u202f≥\u202f28\u202fdays) of the initial buprenorphine prescription.\n\n\nRESULTS\nOver one-half (55%) of individuals discontinued buprenorphine within 180\u202fdays and 13% experienced at least one adverse opioid-related event within 360\u202fdays of initiation. Both a lower initial dose [≤4\u202fmg, OR\u202f=\u202f1.79, p\u202f<\u202f0.01] and fewer initial days of supply [≤7\u202fdays vs. ≥28\u202fdays, OR\u202f=\u202f1.32, p\u202f<\u202f0.01] [8-15\u202fdays vs. ≥28\u202fdays, OR\u202f=\u202f1.22, p\u202f<\u202f0.01] were associated with increased odds of discontinuation. While a lower initial dose was not associated with adverse events, fewer initial days of supply were associated with a higher risk of adverse events, even after controlling for treatment discontinuation.\n\n\nCONCLUSION\nIn this population of commercially insured, non-elderly adults, we found that fewer initial days of supply as well as a lower initial dose were associated with increased likelihood of treatment discontinuation, highlighting the importance of prescribing decisions when initiating buprenorphine for OUD.