Adherence to buprenorphine: An analysis of prescription drug monitoring program data

Pizzicato, Lia N.; Hom, Jeffrey; Sun, Monica; Johnson, Caroline C.; Viner, Kendra

doi:10.1016/j.drugalcdep.2020.108317

Cited by 29 publications

(19 citation statements)

References 43 publications

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“…In addition, our finding that patients maintained on higher doses of buprenorphine are more treatment adherent is consistent with published literature. 26,27 At less than 16 mg, however, the mean daily dose of buprenorphine prescribed to our patients is on the low end of buprenorphine prescribing doses. This could represent an area of clinical improvement and future research, to institute both a systematic assessment of patient satisfaction with dosage and a retention-enhancement protocol using higher dosages.…”

Section: Discussionmentioning

confidence: 92%

“…Several office-based studies have reported that a history of using nonprescribed buprenorphine may increase the likelihood of entering treatment and is associated with improved treatment retention. In addition, our finding that patients maintained on higher doses of buprenorphine are more treatment adherent is consistent with published literature . At less than 16 mg, however, the mean daily dose of buprenorphine prescribed to our patients is on the low end of buprenorphine prescribing doses.…”

Section: Discussionmentioning

confidence: 99%

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Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

et al. 2021

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IMPORTANCE The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated. OBJECTIVE To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020. INTERVENTION Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine. MAIN OUTCOMES AND MEASURES The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients' travel distance to treatment. RESULTS A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients' data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%)were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fiftyfive patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients. CONCLUSIONS AND RELEVANCEThese data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from officebased TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved (continued) Key Points Question Can medications to treat opioid use disorder be effectively provided to individuals living in underserved rural areas via telemedicine in a mobile treatment unit? Findings In this quality improvement study, comparable to office-based telemedicine programs, 58.51% of patients treated in a mobile telemedicine treatment unit remained in treatment at 90 days. Longer retention was significantly associated with reduced opioid...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

et al. 2021

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“…Time-weighted dose of buprenorphine was the most protective treatment factor, reflecting the efficacy of buprenorphine for MOUD [ 7 ]. The finding that increased dose was protective in CTN treatment trials is supported by laboratory studies that show increased buprenorphine doses increase plasma levels, reduce MOR availability and decrease withdrawal symptoms [ 33 ], and by prolonged adherence to greater doses in a prescription drug monitoring program analysis [ 34 ]. Our conceptualization of time-weighted dose is an initial model for recent effects of buprenorphine dose and treatment adherence.…”

Section: Discussionmentioning

confidence: 99%

Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials

Bergen

Baurley

Ervin

et al. 2022

IJERPH

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The impact of agonist dose and of physician, staff and patient engagement on treatment have not been evaluated together in an analysis of treatment for opioid use disorder. Our hypotheses were that greater agonist dose and therapeutic engagement would be associated with reduced illicit opiate use in a time-dependent manner. Publicly-available treatment data from six buprenorphine efficacy and safety trials from the Federally-supported Clinical Trials Network were used to derive treatment variables. Three novel predictors were constructed to capture the time weighted effects of buprenorphine dosage (mg buprenorphine per day), dosing protocol (whether physician could adjust dose), and clinic visits (whether patient attended clinic). We used time-in-trial as a predictor to account for the therapeutic benefits of treatment persistence. The outcome was illicit opiate use defined by self-report or urinalysis. Trial participants (N = 3022 patients with opioid dependence, mean age 36 years, 33% female, 14% Black, 16% Hispanic) were analyzed using a generalized linear mixed model. Treatment variables dose, Odds Ratio (OR) = 0.63 (95% Confidence Interval (95%CI) 0.59–0.67), dosing protocol, OR = 0.70 (95%CI 0.65–0.76), time-in-trial, OR = 0.75 (95%CI 0.71–0.80) and clinic visits, OR = 0.81 (95%CI 0.76–0.87) were significant (p-values < 0.001) protective factors. Treatment implications support higher doses of buprenorphine and greater engagement of patients with providers and clinic staff.

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“…We found that men, blacks, and younger patients (especially IP/IOPs initiators) were at greater risk of attrition, which is consistent with other reports. [26][27][28][29][30][31][32][33] However, this study and the aforementioned reports do not provide an all-encompassing look at structural and implicit biases, thus potentially confounding some of our demographic results. Our findings are also consistent with studies [34][35][36] which found higher attrition rates during BUP treatment for OUD in the context of more concurrent SUDs (eg, stimulant or alcohol use disorders).…”

Section: Discussionmentioning

confidence: 71%

Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records

Ker¹,

Hsu²,

Balani³

et al. 2021

NDT

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To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition. Patients and Methods: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at >37 days following the last recorded visit. Survival analyses and predictive modelling were used. Results: Retention was consistently 2-3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression -Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and nonpsychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%. Conclusion: Of all the OUD patients who began BUP, 50-75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.

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Adherence to buprenorphine: An analysis of prescription drug monitoring program data

Cited by 29 publications

References 43 publications

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

Effects of Buprenorphine Dose and Therapeutic Engagement on Illicit Opiate Use in Opioid Use Disorder Treatment Trials

Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records

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