Could Higher Doses of Buprenorphine Help People With OUD Stay in Treatment?

Higher doses of buprenorphine to treat patients with opioid use disorder (OUD) when fentanyl use is more prevalent could help improve rates of retention in treatment, according to research published in JAMA Network Open.¹

Buprenorphine is one of 3 drugs currently approved by the FDA to treat OUD, the other 2 being methadone and naltrexone. Treatment with buprenorphine has more than doubled since 2009, but dosing guidelines are based on studies with people using heroin that were done before the rise in fentanyl use.

“Effective treatment can save lives, but our proven treatments for opioid use disorders must evolve to match the challenges posed by the fentanyl crisis,” Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), said in a release.²

A team of investigators supported by the NIDA conducted a study to examine if higher doses of buprenorphine treatment for OUD were associated with improved retention in treatment when fentanyl use was higher.

Data was gathered from the Rhode Island Prescription Drug Monitoring Program. The study cohort included 6499 patients who initiated treatment with buprenorphine for OUD between October 1, 2016, and September 30, 2020. The main study outcome was discontinuation of treatment in the 180 days following initiation.

Investigators found that patients who were prescribed a daily dose of 24 mg of buprenorphine were 20% more likely to remain in treatment when compared to patients who were prescribed 16 mg. Patients who were initially prescribed 24 mg were also more likely to have initiated treatment in later years.

“The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl,” Rachel Wightman, MD, an author on the study, said in a release. “Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose—up to 24 mg—may help improve treatment retention for these individuals. We have a responsibility to set patients up for success.”

Reference

1. Chambers LC, Hallowell BD, Zullo AR, et al. Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl. JAMA Netw Open. 2023;6(9):e2334540. doi:10.1001/jamanetworkopen.2023.34540

2. Higher buprenorphine doses associated with improved retention in treatment for opioid use disorder. News Release. NIDA. September 18, 2023. Accessed September 22, 2023. https://nida.nih.gov/news-events/news-releases/2023/09/higher-buprenorphine-doses-associated-with-improved-retention-in-treatment-for-opioid-use-disorder