A new analysis indicates that adults suffering from opioid use disorder who are prescribed higher doses of buprenorphine, a medication for treating opioid addiction, may have a reduced chance of visiting the emergency room or needing inpatient behavioral health services compared to those who receive the standard recommended dose. This study was supported by the National Institutes of Health (NIH) and suggests that administering greater doses of buprenorphine could enhance the management of opioid use disorder, which is particularly crucial in the context of the fentanyl crisis.
Researchers analyzed insurance claims data from over 35,000 individuals diagnosed with opioid use disorder who started buprenorphine treatment between 2016 and 2021. They discovered that 12.5% of these patients had to visit the emergency room or stay in a hospital for behavioral health issues during the study period. After accounting for various patient demographics and medical histories found in the data, the researchers examined the duration before patients on different buprenorphine doses required emergency care or inpatient services after initiating treatment.
The FDA’s approved guidelines suggest a target daily dose of 16 mg of buprenorphine. The findings revealed that patients taking higher daily doses (ranging from over 16 mg to 24 mg) experienced a 20% longer wait before needing a subsequent emergency or inpatient visit for behavioral health within the first year of treatment, in comparison to those on doses between 8 mg and 16 mg. Furthermore, patients receiving more than 24 mg daily were able to go 50% longer before needing similar services in the same timeframe.
“With the ongoing overdose crisis, especially due to the increase in fentanyl use, it’s essential to explore how we can effectively adapt and provide the life-saving, evidence-based treatments available for opioid use disorder,” said Nora D. Volkow, M.D., director of the NIH’s National Institute on Drug Abuse (NIDA). “These results contribute to the expanding data suggesting that higher doses of buprenorphine could have significant health benefits for those suffering from opioid use disorder.”
In 2022, nearly 108,000 overdose fatalities recorded in the U.S. showed that about 70% were primarily linked to fentanyl, a synthetic opioid that is roughly 50 times more potent than heroin. The pervasive presence of fentanyl in the drug market and the related overdose incidents have prompted discussions on whether current buprenorphine dosing recommendations should be revised to better address the distinctive challenges that this powerful opioid presents. Increased doses of buprenorphine may be necessary to adequately manage the intense withdrawal symptoms, cravings, and tolerance associated with fentanyl usage.
“Delaying or preventing the need for urgent, intensive healthcare calls for major improvements in health outcomes and recovery prospects for people with opioid use disorder,” stated Bradley D. Stein, M.D., Ph.D., co-author of the study and director at the RAND-USC Schaeffer Opioid Policy Tools and Information Center. “As we continue to gather and analyze data from various studies, the evidence points toward higher buprenorphine doses potentially offering substantial improvements in treatment, particularly in the context of ongoing high rates of both fatal and nonfatal overdoses.”
The authors emphasize that overcoming barriers to accessing higher doses, such as state regulations and insurance limitations, will be critical for ensuring that all patients receive adequate treatment. They also suggest re-evaluating guidelines that limit higher dosing since these could prevent patients at high risk for relapse or overdose from receiving life-saving care.
It’s important to note that the data utilized in this study originated from a single commercial insurance firm, which does not represent the uninsured population or those with Medicaid or fee-for-service Medicare coverage. Additionally, the group analyzed was predominantly (75%) non-Hispanic white. More research is needed to assess the effect of higher buprenorphine doses in a more varied demographic, including individuals with different insurance types or in various clinical settings. Future studies should also look into long-term outcomes related to high-dose buprenorphine treatment and its impact on retention in opioid use disorder care and overall health.
These findings reinforce the growing evidence supporting the safety and effectiveness of using higher doses of buprenorphine. Prior studies indicate that doses exceeding 16 mg of buprenorphine are safe and well-tolerated in emergency and outpatient treatment contexts, correlating with improved retention rates in treatment for opioid use disorder.
This research was financed by NIH’s NIDA and published in JAMA Network Open. The data analyzed stemmed from a substantial database of commercial insurance claims, which also encompassed those for Medicare Advantage.
