Medications for opioid use disorder such as buprenorphine can securely and efficiently support reduction in opioid use and overdose along with recovery by reducing opioid yearnings and alleviating withdrawal symptoms. These findings construct upon building up evidence of the safety and efficacy of higher dosages of buprenorphine. Research studies have actually revealed that more than 16 mg of buprenorphine is safe and well endured in individuals with opioid usage disorder in emergency department and outpatient treatment settings.
The Need for Treatment Evolution Amidst the Fentanyl Crisis
” Effective treatment can conserve lives, however our tested treatments for opioid use conditions need to develop to match the difficulties postured by the fentanyl crisis,” stated NIDA Director, Nora Volkow, M.D. “If science continues to show that a higher dosage of buprenorphine increases treatment retention, we should reassess medical guidelines to optimize treatment and assist individuals achieve recovery.”
In 2021, of nearly 107,000 overdose deaths reported, more than 70,000 were mainly due to fentanyl, an artificial opioid that is approximately 50 times stronger than heroin. The ubiquity of fentanyl in the drug supply and the resulting overdose death rate boost have actually raised concerns about whether existing dosing guidelines for buprenorphine must be modified to much better address the unique difficulties posed by such a potent opioid. Presently, labeling approved by the FDA states that maintenance dosages must vary from 4 mg to 24 mg, with a suggested target dosage of 16 mg per day for a lot of clients. Suggested dosages for treatment can likewise vary extensively depending on the persons requirements and reaction to the medication.
Study Parameters and Results
In this study, scientists retrospectively analyzed data from a statewide population of 6,499 Rhode Island homeowners initiating buprenorphine as part of treatment for opioid usage condition from 2016 to 2020, a period of fentanyl emergence and predominance. The goal was to approximate the association between clients day-to-day buprenorphine dose and retention in treatment over 180 days, a timespan that aligns with the minimum treatment duration considered by the U.S. Centers for Medicare and Medicaid Services to determine treatment continuity for opioid usage condition.
The majority of clients were aged 25 to 44 years, were male, and had private or Medicaid insurance. At the initiation of buprenorphine treatment, approximately 21% (1,343 patients) were prescribed 8 mg, 50% (3,264 clients) 16 mg, and 10% (668 clients) 24 mg. Those recommended more than 24 mg were not able to be examined due to the small number (0.2%, or 15 clients) recommended such doses during the study duration.
Patients prescribed a 24 mg dosage of buprenorphine were retained in treatment for a longer duration than those prescribed the advised target maintenance dose of 16 mg. An analytical analysis showed the latter group was 20% more most likely to terminate treatment than those prescribed 24 mg.
” The existing recommended target dosage of buprenorphine was originated from studies conducted prior to the extensive schedule of fentanyl. Now, were seeing people with higher levels of tolerance to and dependence on opioids, and our findings recommend that a higher buprenorphine dose– up to 24 mg– might help improve treatment retention for these people,” said Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the principal private investigators of the study. “We have an obligation to set patients up for success.”
Future Research Directions
To continue this research study, scientists intend to carry out a potential randomized scientific trial to evaluate the effect of day-to-day buprenorphine dosages up to 24 mg in enhancing treatment retention and reducing the danger of overdose and death. Within this trial, the researchers will likewise investigate the role of other factors that may be related to treatment retention, consisting of clinician prescribing practices, in addition to patient socio-demographics and life circumstances. Findings from this trial could ultimately help inform updates to opioid use condition treatment standards.
Reference: “Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl” by Laura C. Chambers, PhD, MPH; Benjamin D. Hallowell, PhD, MPH; Andrew R. Zullo, PharmD, PhD; Taylor J. Paiva, MPH; Justin Berk, MD, MPH, MBA; Rachel Gaither, BS; Aidan J. Hampson, PhD; Francesca L. Beaudoin, MD, PhD and Rachel S. Wightman, MD, FACMT, 18 September 2023, JAMA Network Open.DOI: 10.1001/ jamanetworkopen.2023.34540.
The study was moneyed by the National Institute on Drug Abuse, part of the National Institutes of Health under award number UG3DA056880. The material is entirely the responsibility of the authors and does not always represent the official views of the National Institutes of Health.
Individuals with opioid usage condition who were prescribed a lower buprenorphine dosage were 20% more most likely to stop treatment than those on a higher dosage. Suggested dosages for treatment can likewise differ extensively depending on the persons needs and response to the medication.
At the initiation of buprenorphine treatment, roughly 21% (1,343 patients) were recommended 8 mg, 50% (3,264 clients) 16 mg, and 10% (668 patients) 24 mg. Now, were seeing people with higher levels of tolerance to and dependence on opioids, and our findings recommend that a greater buprenorphine dosage– up to 24 mg– may assist improve treatment retention for these individuals,” stated Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the primary investigators of the study. To continue this research study, researchers intend to perform a potential randomized scientific trial to examine the effect of day-to-day buprenorphine doses up to 24 mg in enhancing treatment retention and minimizing the danger of overdose and death.
A Rhode Island research study exposes that opioid usage disorder patients on lower buprenorphine doses have a 20% greater dropout rate, recommending the need to reevaluate dosing guidelines amidst the fentanyl crisis.
NIH-funded research study suggests the requirement to reevaluate opioid dependency treatment recommendations in the era of fentanyl.
Individuals with opioid usage disorder who were prescribed a lower buprenorphine dose were 20% most likely to discontinue treatment than those on a higher dosage. This is according to a research study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became commonly available. The research study was released on September 18 in JAMA Network Open. It was supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and conducted by researchers at Brown University, Providence, Rhode Island; NIDA and the Rhode Island Department of Health.
Dosing Recommendations and Patient Responses
Amongst clients newly starting buprenorphine treatment for opioid usage disorder, 59% of those prescribed the target daily dose of 16 milligrams recommended by the U.S. Food and Drug Administration (FDA) and 53% of those prescribed the higher 24 mg everyday dosage stopped treatment within 180 days. A statistical analysis that permitted multivariable comparison of these 2 dosage groups revealed clients prescribed the recommended dose (16 mg) were considerably more likely to stop treatment over 180 days compared to those prescribed 24 mg.