PROVIDENCE, R.I. [Brown University] — People with opioid use disorder who received a lower buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to new research.
The study, published today 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. It was conducted by researchers at Brown University, the National Institute on Drug Abuse and the Rhode Island Department of Health.
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 target daily dose recommended by the U.S. Food and Drug Administration is 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 noted.
“Medications for opioid use disorder, such as buprenorphine, are life-saving, but only if people start them and stay on them,” said study author Dr. Francesca Beaudoin, a professor of epidemiology and emergency medicine at Brown. “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 said. 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.
