Monthly Buprenorphine Initiation Rates Remain Flat, Despite Policy Changes

Despite several policy changes that aimed to increase access to buprenorphine during the COVID-19 pandemic, monthly initiation rates of buprenorphine therapy have remained flat, according to research results.¹

The study, published in JAMA, was conducted by a team of researchers from the University of Michigan and Boston University who sought to assess trends in buprenorphine initiation and retention from 2016 through 2022.

“Prior studies have examined buprenorphine initiation and retention rates through the end of 2020,” the researchers wrote. “However, buprenorphine access may have since improved owing to the implementation of policies to increase use, such as the elimination of training requirements for buprenorphine waivers in April 2021.”

The investigators utilized data from the IQVIA Longitudinal Prescription Database, which reports 92% of prescriptions dispensed in US retail pharmacies. The study examined 93,713,163 buprenorphine prescriptions dispensed from January 2016 through October 2022.

The monthly buprenorphine initiation rate was defined as the number of patients initiating buprenorphine therapy per 100,000 individuals. Patients were identified based on an “initial” buprenorphine prescription, which was defined as a prescription for a patient without buprenorphine dispensing in the prior 180 days.

Buprenorphine products included both immediate-release and extended-release formulations approved for opioid use disorder, but not those primarily used to treat pain. Prescriptions for patients who had a buprenorphine prescription with missing or potentially invalid data on days supplied were excluded.

Findings from the research showed that 3,006,629 patients initiated buprenorphine therapy during the study period, of which 42.9% were female. The monthly buprenorphine initiation rate increased from 12.5 to 15.9 per 100,000 patients between January 2016 and September 2018. However, monthly initiation rates were flat from October 2018 through October 2022.

The median monthly buprenorphine initiation rate was slightly lower during March 2020 through December 2020, compared to January 2019 through February 2020 and January 2021 through October 2022.

Additionally, the study found that only 1 in 5 patients who had initiated buprenorphine were retained in therapy for at least 180 days.

Study limitations include a lack of data on race and ethnicity, buprenorphine dispensing in methadone outpatient treatment programs, in-clinic buprenorphine administration and that some patients may have initiated buprenorphine to treat pain.

“These findings suggest that recent clinical and policy efforts to increase buprenorphine use have been insufficient to meet the need for this medication,” the investigators concluded. “A comprehensive approach is needed to eliminate barriers to buprenorphine initiation and retention, such as stigma and uneven access to prescribers.”

Reference

1. Chua K, Nguyen TD, Zhang J, Conti RM, Lagisetty P, Bohnert AS. Trends in Buprenorphine Initiation and Retention in the United States, 2016-2022. J Am Med Assoc. 2023;329(16):1402–1404. doi:10.1001/jama.2023.1207.