Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort

Details

• Alternative Title:
  Drug Alcohol Depend
• Personal Author:
  MORGAN, Jake R. ; WALLEY, Alexander Y. ; MURPHY, Sean M. ; CHATTERJEE, Avik ; HADLAND, Scott E. ; BAROCAS, Joshua ; LINAS, Benjamin P. ; ASSOUMOU, Sabrina A.
• Description:
  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.
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• Subjects:
  • Analgesics, Opioid
  • Buprenorphine
  • Delayed-Action Preparations
  • Humans
  • Methadone
  • Naltrexone
  • Opiate Substitution Treatment
  • Opioid-Related Disorders
• Keywords:
  • opioid use disorder
  • extended-release buprenorphine
  • medication for opioid use disorder
  • retention
• Source:
  Drug Alcohol Depend. 225:108764
• Pubmed ID:
  34051547
• Pubmed Central ID:
  PMC8488795
• Document Type:
  Journal Article
• Funding:
  R01 DA046527/DA/NIDA NIH HHSUnited States/ ; P30 DA040500/DA/NIDA NIH HHSUnited States/ ; R01CE002999/ACL/ACL HHSUnited States/ ; R01 CE002999/CE/NCIPC CDC HHSUnited States/ ; K23 DA044085/DA/NIDA NIH HHSUnited States/ ; P30 AI042853/AI/NIAID NIH HHSUnited States/
• Place as Subject:
  United States
• Volume:
  225
• Download URL:
  https://stacks.cdc.gov/view/cdc/110380/cdc_110380_DS1.pdf
• File Type:
  [PDF - 701.80 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:52ffccb571bc3caaa806a531bcd0b6585237c6dfc08f435c799f919ca50f2642