Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration.

BACKGROUND

Retention of patients in buprenorphine medication treatment for opioid use disorder (B-MOUD) reduces harms associated with opioid use disorder (OUD). We sought to characterize the patients receiving B-MOUD and courses of B-MOUD in a large healthcare system.

METHODS

We conducted a retrospective, open cohort study of patients with OUD who either did or did not receive B-MOUD courses within the Veterans Health Administration (VHA) from January 2006 through July 2019, using VHA clinical data. We compared patients receiving or not receiving B-MOUD, characterized B-MOUD courses (e.g., length and doses), and examined persistence, across patient characteristics, over time. We used analyses for normally or non-normally distributed continuous variables, categorical data, and persistence over time (Kaplan-Meier persistence curves).

RESULTS

We identified 255,726 Veterans with OUD; 40,431 (15.8%) had received 63,929 B-MOUD courses. Compared to patients with OUD without B-MOUD, patients with B-MOUD were younger, more often of white race, and had more co-morbidities. The frequency of new B-MOUD starts and prevalent B-MOUD patients ranged from 1550 and 1989 in 2007 to 8146 and 16,505 in 2018, respectively. The median duration of B-MOUD was 157 (IQR: 37-537) days for all courses and 33.8% patients had more than one course. The average proportion days covered was 90% (SD: 0.15), and the average prescribed daily dose was 13.44 (SD: 6.5).

CONCLUSIONS

Within a VHA B-MOUD cohort, courses increased more than 10-fold from 2006 to 2016 with nearly half of patients experiencing multiple courses. Patient demographics seem to dictate the length of courses.

Informations de copyright

Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of Competing Interest AJG receives an honorarium for an online chapter on alcohol management in the perioperative period from Wolters-Kluwer; is on the board of directors (not-for profit; not remunerated) for the American Society of Addiction Medicine (ASAM), the Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA), and the International Society of Addiction Journal Editors (ISAJE), all non-for profit organizations; and receives current grant support from the Veterans Health Administration (VHA) and NIH. SGK receives an honorarium for an online chapter on homeless health care from Wolters-Kluwer, and research grant funding from the Veterans Health Administration (VHA). He serves on the board of scientific advisors (not-for-profit; not remunerated) of both the National Pain Advocacy Center and the Albert Schweitzer Fellowship, Inc. He reports current ownership of stock in medical product companies unrelated to this topic, Zimmer Biomet, Dow and Thermo Fisher. He reports stock ownership in CVS/Caremark in 2020, only.