A recent study conducted by researchers at Brown University, NIDA, and the Rhode Island Department of Health has found that individuals with opioid use disorder who were prescribed a lower dose of buprenorphine were more likely to discontinue treatment compared to those on a higher dose. The study, supported by the National Institute on Drug Abuse, analyzed data from over 6,400 Rhode Island residents initiating buprenorphine treatment between 2016 and 2020.
Of the patients receiving buprenorphine treatment, 59% of those prescribed the recommended daily dose of 16 milligrams and 53% of those prescribed a higher dose of 24 mg discontinued treatment within 180 days. A statistical analysis revealed that patients prescribed the lower dose were significantly more likely to discontinue treatment compared to those on the higher dose.
Buprenorphine is a medication used to treat opioid use disorder by reducing cravings and easing withdrawal symptoms. The findings of this study support the growing evidence that higher doses of buprenorphine are safe and effective in the treatment of opioid use disorder. Previous studies have shown that doses greater than 16 mg are well tolerated in emergency department and outpatient settings.
The emergence of fentanyl, a highly potent synthetic opioid, has raised questions about whether current dosing guidelines for buprenorphine should be modified to better address the challenges posed by this potent opioid. In 2021, over 70,000 overdose deaths were primarily attributed to fentanyl.
The current recommended target dose of buprenorphine, derived from studies conducted before the widespread availability of fentanyl, may no longer be optimal for individuals with higher tolerance and dependence on opioids. This study suggests that a higher dose, up to 24 mg, may improve treatment retention for these individuals.
Further research is needed to assess the impact of higher doses of buprenorphine on treatment retention, as well as to investigate other factors that may be associated with treatment outcomes. A prospective randomized clinical trial is planned to evaluate the effectiveness of daily buprenorphine doses up to 24 mg in improving treatment retention and reducing the risk of overdose and death.
In conclusion, this study highlights the importance of considering higher doses of buprenorphine in the treatment of individuals with opioid use disorder, especially in the face of the fentanyl crisis. By optimizing treatment, we can potentially save lives and help individuals achieve recovery from opioid addiction.
Sources:
– Study: Chambers, L. C., et al. (2023) Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl. JAMA Network Open.
– National Institute on Drug Abuse (NIDA)
