Dose-specific clinical outcomes in patients with opioid use disorder treated with 24-32 mg/day of buprenorphine

Julia D'Agata Mount, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Junfeng Sun, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Ashley Davis, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Amelia Cover, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Lily Sun, Haverford College, Haverford, PA, USA.
Catherine Gannon, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Meghan Derenoncourt, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Grace Garrett, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Rahwa Eyasu, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Emade Ebah, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Phyllis Bijole, HIPS, Org, Washington, DC, USA.
Aaron Greenblatt, Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
Sarah Kattakuzhy, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Elana Rosenthal, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

7-8-2024

Journal

Addiction (Abingdon, England)

DOI

10.1111/add.16600

Keywords

Buprenorphine; harm Reduction; high‐dose buprenorphine; opioid epidemic; opioid use disorder; substance use

Abstract

BACKGROUND/AIMS: In people with opioid use disorder (OUD), buprenorphine is a vital treatment to decrease opioid use and overdose. The US Food and Drug Administration's prescribing information for buprenorphine advises dosing up to 24 mg/day; however, doses of buprenorphine up to 32 mg have been shown to be safe and effective. We compared outcomes associated increased dosing from 24 to 32 mg/day. DESIGN: Prospective cohort investigation. SETTING: Low-barrier buprenorphine clinic in Washington, District of Columbia, USA. PARTICIPANTS: Participants in the ANCHOR study (people with hepatitis C virus (HCV), OUD, and active opioid misuse who were treated for HCV and offered buprenorphine) who received buprenorphine at doses of 24 and/or 32 mg/day. 72 participants were included in the analysis: 24 (33%) patients stabilized on 24 mg, and 48 (67%) patients stabilized on 32 mg. Patients were predominantly male (78%), Black (96%), unstably housed (57%), and used opioids by injection (93%). MEASUREMENTS: Patient-reported drug use, use frequency, triggers for use, and urine drug screens were collected at each visit. For analysis, the cohort was divided into individuals stabilized on 24 mg (24 mg cohort) or 32 mg (32 mg cohort). Drug use outcomes were assessed between cohorts at 24 mg dosing and at respective maximum dosing. Within the 32 mg cohort, outcomes were compared at 24 mg versus 32 mg dosing. FINDINGS: Within the 32 mg cohort, increased dosing from 24 to 32 mg was associated with a decline in opioid use (68.5% [5.2%] at 24 mg vs 59.5% [5.6%] at 32 mg; P = 0.02), frequency of use per week (1.58 [0.19] at 24 mg vs. 1.15 [0.16] at 32 mg; P = 0.0002) and physiologic triggers for use (38.2% [6.0%] at 24 mg vs 7.0% [1.9%] at 32 mg; P < 0.0001). At the end of the study period, there were significantly more patients retained in the 32 mg cohort (78.7%) compared with the 24 mg cohort (50.0%, P = 0.02). CONCLUSION: Higher buprenorphine dosing (32 mg/day) appears to improve outcomes in people with opioid use disorder, even in the absence of abstinence.

Department

School of Medicine and Health Sciences Student Works

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