Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort.
Extended-release buprenorphine
Medication for opioid Use disorder
Opioid use disorder
Retention
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
received:
27
01
2021
revised:
23
03
2021
accepted:
10
04
2021
pubmed:
30
5
2021
medline:
22
9
2021
entrez:
29
5
2021
Statut:
ppublish
Résumé
While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort. United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone. Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose. We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment. Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.
Sections du résumé
BACKGROUND AND AIMS
While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort.
SETTING
United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone.
MEASUREMENTS
Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose.
FINDINGS
We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment.
CONCLUSIONS
Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.
Identifiants
pubmed: 34051547
pii: S0376-8716(21)00259-3
doi: 10.1016/j.drugalcdep.2021.108764
pmc: PMC8488795
mid: NIHMS1708985
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Delayed-Action Preparations
0
Buprenorphine
40D3SCR4GZ
Naltrexone
5S6W795CQM
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
108764Subventions
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : ACL HHS
ID : R01CE002999
Pays : United States
Organisme : NCIPC CDC HHS
ID : R01 CE002999
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA044085
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
Am J Addict. 2020 Jul;29(4):345-348
pubmed: 32167629
Am J Public Health. 2018 Dec;108(12):1675-1681
pubmed: 30359112
J Subst Abuse Treat. 2021 Sep;128:108262
pubmed: 33419602
Addiction. 2020 Jul;115(7):1295-1305
pubmed: 31860767
JAMA Netw Open. 2021 Feb 1;4(2):e2037259
pubmed: 33587136
JAMA Netw Open. 2021 Feb 1;4(2):e2037385
pubmed: 33587129
Science. 2018 Sep 21;361(6408):
pubmed: 30237320
Drug Alcohol Depend. 2019 Jul 1;200:34-39
pubmed: 31082666
J Subst Abuse Treat. 2010 Jul;39(1):22-31
pubmed: 20418051
JAMA Netw Open. 2020 Feb 5;3(2):e1920622
pubmed: 32022884
Psychiatr Serv. 2021 Feb 1;72(2):225-226
pubmed: 32907476
Lancet. 2010 May 29;375(9729):1885-95
pubmed: 20511018
Addiction. 2021 Jan;116(1):96-104
pubmed: 32428386
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720932017
pubmed: 32507067
MMWR Morb Mortal Wkly Rep. 2019 Jan 18;68(2):37-40
pubmed: 30653482
J Addict Med. 2021 May-Jun 01;15(3):252-254
pubmed: 32925232
Drug Alcohol Depend. 2013 Jul 1;131(1-2):119-26
pubmed: 23317685
J Subst Abuse Treat. 2018 Feb;85:90-96
pubmed: 28733097
J Addict Dis. 2016;35(1):22-35
pubmed: 26467975
JAMA Netw Open. 2020 Dec 1;3(12):e2029676
pubmed: 33320266
JAMA Intern Med. 2018 Jun 1;178(6):764-773
pubmed: 29799968
Addiction. 2020 Jul;115(7):1306-1307
pubmed: 32304255
Addict Sci Clin Pract. 2020 Apr 22;15(1):15
pubmed: 32321570
Lancet. 2019 Feb 23;393(10173):778-790
pubmed: 30792007
J Addict Med. 2021 Jan-Feb 01;15(1):15-17
pubmed: 32604134
JAMA Pediatr. 2017 Aug 1;171(8):747-755
pubmed: 28628701
Addiction. 2021 Oct;116(10):2600-2609
pubmed: 33651441
J Addict Med. 2019 Nov/Dec;13(6):442-449
pubmed: 30844878
JAMA Pediatr. 2018 Nov 1;172(11):1029-1037
pubmed: 30208470
J Addict Med. 2015 Sep-Oct;9(5):358-67
pubmed: 26406300
N C Med J. 2020 May-Jun;81(3):210-211
pubmed: 32366637
J Subst Abuse Treat. 2020 Apr;111:54-66
pubmed: 32076361
MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):837-43
pubmed: 27560775
Med Care. 1998 Jan;36(1):8-27
pubmed: 9431328
J Subst Abuse Treat. 2017 Mar;74:65-70
pubmed: 28132702
Subst Abuse Rehabil. 2020 Nov 02;11:41-47
pubmed: 33173372
N Engl J Med. 2017 Jul 27;377(4):391-394
pubmed: 28564549
Psychiatr Serv. 2020 Mar 1;71(3):303-306
pubmed: 31822242