Buprenorphine, often prescribed with naloxone under the brand name Suboxone, is an evidence-based medication for people with opioid use disorder. Clinical wisdom suggests staying on the medication consistently is important to patient outcomes. But does consistent adherence really make a difference?
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As outlined in another highlighted article in this issue of the Recovery Bulletin, buprenorphine (Suboxone) is an effective medication-assisted treatment for opioid use disorder, especially at doses 16 mg or greater. This is also true over the long term, as individuals receiving buprenorphine treatment in one study example, had 8 fewer days of opioid use each month, on average, across a 5-year follow-up compared to individuals on no medication-assisted treatment.
Although there are not many naturalistic studies of patients in real-world buprenorphine (Suboxone) treatment, the studies that have been done suggest 50-90% will be in treatment 12-18 months later (see here). In this study, Lo-Ciganic and colleagues were interested in how different patterns of remaining versus dropping out of buprenorphine treatment across an entire year were related to two important health care outcomes: hospitalization and emergency room visits.
This study analyzed Pennsylvania Medicaid claims of 10,945 buprenorphine prescriptions from 2007 to 2012. In each case, the authors analyzed the data 12 months after this initial (sometimes called “index”) buprenorphine prescription.
They used a sophisticated analysis to establish six buprenorphine (Suboxone) prescription patterns over the course of the year:
To try and obtain a sample prescribed buprenorphine (Suboxone) just as a maintenance treatment medication for opioid use disorder, the authors excluded those with just one prescription – as this could have been for detoxification – and those with injection or transdermal (skin patch) formulations – as these are most often prescribed for pain management. Patients could not have had a buprenorphine prescription in the 6 months prior to the initial prescription used in this study. It is worth noting that one-third had a methadone prescription in the 6 months before the initial buprenorphine prescription used in the study. Consequently, these individuals had already experienced medication-assisted treatment, and with a full agonist (methadone) instead of the partial opioid agonist, buprenorphine, examined in this study.
Study authors compared five of the groups to the group who discontinued 3-5 months after the initial buprenorphine (Suboxone) prescription regarding their risk for being hospitalized (for any reason) and for being admitted to the emergency department across the entire 12 months. They controlled statistically for many demographic, social, and clinical factors that could influence these two primary outcomes. This statistical control was done to isolate the effect of these six different buprenorphine prescription patterns on the outcomes. The study sample was 18-64 years old (33 on average), 58% Female and 89% White. Most (85%) received buprenorphine from their primary care doctors.
Before controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
After controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
As might be expected, overall, most of the hospitalizations were related to substance use or mental health disorders (76%).
Those who discontinued and restarted had 24% greater risk of an emergency department visit than those who discontinued during months 3-5.
For individuals who are prescribed Suboxone, this research highlights the importance of taking the medication on a consistent basis over the 1st year.
For those who restarted their medication after discontinuing, their greater “risk” of having visited the emergency department is probably best understood in the opposite direction. That is, they were likely restarted on buprenorphine after having visited the emergency room.
Also important was that rates of drop-out were much higher (69% of those initially prescribed the mediation) in this study than had been reported in previous studies. One possibility as to why is that engaging with a buprenorphine specialty program (i.e., that caters specifically to individuals receiving buprenorphine for opioid use disorder) provides services that help facilitate ongoing adherence to buprenorphine relative to a primary care physician. In this study, however, primary care physicians prescribed the medication for 85% of the sample in this study. Another possibility, is simply that individuals who engage with specialty programs are more motivated for treatment.
This timely and well done study should be replicated in other states and in samples of individuals with other health care plans. Also, studies of buprenorphine (Suboxone) outcomes for similar groups of individuals receiving treatment in specialty programs versus primary care physicians may be worthwhile.
Lo‐Ciganic, W. H., Gellad, W. F., Gordon, A. J., Cochran, G., Zemaitis, M. A., Cathers, T., … & Donohue, J. M. (2016). Association between Trajectories of Buprenorphine Treatment and Emergency Department and In‐patient Utilization. Addiction.
l
As outlined in another highlighted article in this issue of the Recovery Bulletin, buprenorphine (Suboxone) is an effective medication-assisted treatment for opioid use disorder, especially at doses 16 mg or greater. This is also true over the long term, as individuals receiving buprenorphine treatment in one study example, had 8 fewer days of opioid use each month, on average, across a 5-year follow-up compared to individuals on no medication-assisted treatment.
Although there are not many naturalistic studies of patients in real-world buprenorphine (Suboxone) treatment, the studies that have been done suggest 50-90% will be in treatment 12-18 months later (see here). In this study, Lo-Ciganic and colleagues were interested in how different patterns of remaining versus dropping out of buprenorphine treatment across an entire year were related to two important health care outcomes: hospitalization and emergency room visits.
This study analyzed Pennsylvania Medicaid claims of 10,945 buprenorphine prescriptions from 2007 to 2012. In each case, the authors analyzed the data 12 months after this initial (sometimes called “index”) buprenorphine prescription.
They used a sophisticated analysis to establish six buprenorphine (Suboxone) prescription patterns over the course of the year:
To try and obtain a sample prescribed buprenorphine (Suboxone) just as a maintenance treatment medication for opioid use disorder, the authors excluded those with just one prescription – as this could have been for detoxification – and those with injection or transdermal (skin patch) formulations – as these are most often prescribed for pain management. Patients could not have had a buprenorphine prescription in the 6 months prior to the initial prescription used in this study. It is worth noting that one-third had a methadone prescription in the 6 months before the initial buprenorphine prescription used in the study. Consequently, these individuals had already experienced medication-assisted treatment, and with a full agonist (methadone) instead of the partial opioid agonist, buprenorphine, examined in this study.
Study authors compared five of the groups to the group who discontinued 3-5 months after the initial buprenorphine (Suboxone) prescription regarding their risk for being hospitalized (for any reason) and for being admitted to the emergency department across the entire 12 months. They controlled statistically for many demographic, social, and clinical factors that could influence these two primary outcomes. This statistical control was done to isolate the effect of these six different buprenorphine prescription patterns on the outcomes. The study sample was 18-64 years old (33 on average), 58% Female and 89% White. Most (85%) received buprenorphine from their primary care doctors.
Before controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
After controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
As might be expected, overall, most of the hospitalizations were related to substance use or mental health disorders (76%).
Those who discontinued and restarted had 24% greater risk of an emergency department visit than those who discontinued during months 3-5.
For individuals who are prescribed Suboxone, this research highlights the importance of taking the medication on a consistent basis over the 1st year.
For those who restarted their medication after discontinuing, their greater “risk” of having visited the emergency department is probably best understood in the opposite direction. That is, they were likely restarted on buprenorphine after having visited the emergency room.
Also important was that rates of drop-out were much higher (69% of those initially prescribed the mediation) in this study than had been reported in previous studies. One possibility as to why is that engaging with a buprenorphine specialty program (i.e., that caters specifically to individuals receiving buprenorphine for opioid use disorder) provides services that help facilitate ongoing adherence to buprenorphine relative to a primary care physician. In this study, however, primary care physicians prescribed the medication for 85% of the sample in this study. Another possibility, is simply that individuals who engage with specialty programs are more motivated for treatment.
This timely and well done study should be replicated in other states and in samples of individuals with other health care plans. Also, studies of buprenorphine (Suboxone) outcomes for similar groups of individuals receiving treatment in specialty programs versus primary care physicians may be worthwhile.
Lo‐Ciganic, W. H., Gellad, W. F., Gordon, A. J., Cochran, G., Zemaitis, M. A., Cathers, T., … & Donohue, J. M. (2016). Association between Trajectories of Buprenorphine Treatment and Emergency Department and In‐patient Utilization. Addiction.
l
As outlined in another highlighted article in this issue of the Recovery Bulletin, buprenorphine (Suboxone) is an effective medication-assisted treatment for opioid use disorder, especially at doses 16 mg or greater. This is also true over the long term, as individuals receiving buprenorphine treatment in one study example, had 8 fewer days of opioid use each month, on average, across a 5-year follow-up compared to individuals on no medication-assisted treatment.
Although there are not many naturalistic studies of patients in real-world buprenorphine (Suboxone) treatment, the studies that have been done suggest 50-90% will be in treatment 12-18 months later (see here). In this study, Lo-Ciganic and colleagues were interested in how different patterns of remaining versus dropping out of buprenorphine treatment across an entire year were related to two important health care outcomes: hospitalization and emergency room visits.
This study analyzed Pennsylvania Medicaid claims of 10,945 buprenorphine prescriptions from 2007 to 2012. In each case, the authors analyzed the data 12 months after this initial (sometimes called “index”) buprenorphine prescription.
They used a sophisticated analysis to establish six buprenorphine (Suboxone) prescription patterns over the course of the year:
To try and obtain a sample prescribed buprenorphine (Suboxone) just as a maintenance treatment medication for opioid use disorder, the authors excluded those with just one prescription – as this could have been for detoxification – and those with injection or transdermal (skin patch) formulations – as these are most often prescribed for pain management. Patients could not have had a buprenorphine prescription in the 6 months prior to the initial prescription used in this study. It is worth noting that one-third had a methadone prescription in the 6 months before the initial buprenorphine prescription used in the study. Consequently, these individuals had already experienced medication-assisted treatment, and with a full agonist (methadone) instead of the partial opioid agonist, buprenorphine, examined in this study.
Study authors compared five of the groups to the group who discontinued 3-5 months after the initial buprenorphine (Suboxone) prescription regarding their risk for being hospitalized (for any reason) and for being admitted to the emergency department across the entire 12 months. They controlled statistically for many demographic, social, and clinical factors that could influence these two primary outcomes. This statistical control was done to isolate the effect of these six different buprenorphine prescription patterns on the outcomes. The study sample was 18-64 years old (33 on average), 58% Female and 89% White. Most (85%) received buprenorphine from their primary care doctors.
Before controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
After controlling statistically for demographic, social, and clinical factors, those who refilled persistently had:
As might be expected, overall, most of the hospitalizations were related to substance use or mental health disorders (76%).
Those who discontinued and restarted had 24% greater risk of an emergency department visit than those who discontinued during months 3-5.
For individuals who are prescribed Suboxone, this research highlights the importance of taking the medication on a consistent basis over the 1st year.
For those who restarted their medication after discontinuing, their greater “risk” of having visited the emergency department is probably best understood in the opposite direction. That is, they were likely restarted on buprenorphine after having visited the emergency room.
Also important was that rates of drop-out were much higher (69% of those initially prescribed the mediation) in this study than had been reported in previous studies. One possibility as to why is that engaging with a buprenorphine specialty program (i.e., that caters specifically to individuals receiving buprenorphine for opioid use disorder) provides services that help facilitate ongoing adherence to buprenorphine relative to a primary care physician. In this study, however, primary care physicians prescribed the medication for 85% of the sample in this study. Another possibility, is simply that individuals who engage with specialty programs are more motivated for treatment.
This timely and well done study should be replicated in other states and in samples of individuals with other health care plans. Also, studies of buprenorphine (Suboxone) outcomes for similar groups of individuals receiving treatment in specialty programs versus primary care physicians may be worthwhile.
Lo‐Ciganic, W. H., Gellad, W. F., Gordon, A. J., Cochran, G., Zemaitis, M. A., Cathers, T., … & Donohue, J. M. (2016). Association between Trajectories of Buprenorphine Treatment and Emergency Department and In‐patient Utilization. Addiction.
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