Continuous Buprenorphine Treatment Lowers Prescription Opioid Use

May 11, 2020 - Long-term buprenorphine treatment was linked to significantly lower rates of prescription opioid use and opioid-related events, including medically treated overdoses, according to a study from Columbia University Mailman School of Public Health.

The study results published in the May issue of Health Affairs found that individuals who continued buprenorphine treatment saw improvements in overall healthcare outcomes. 

Compared to 4,433 adults who discontinued buprenorphine six to nine months after beginning treatment, individuals with continued treatment saw a significantly lower risk of all-cause inpatient (52 percent) and emergency department services (26 percent).

Researchers also observed reductions in opioid-related hospital services (128 percent), overdose events (173 percent), and opioid prescriptions (120 percent) in the follow-up period than in the treatment period. 

Additionally, researchers reported that there was a 124 percent lower rate of prescription opioid use in the follow-up as well. 

"Buprenorphine is an effective medication for the treatment of opioid addiction, yet until now studies were not designed to establish a minimum duration of treatment for opioid use disorder needed to achieve improved clinical outcomes," said Hillary Samples, PhD, postdoctoral research fellow in the department of epidemiology, Columbia University Mailman School of Public Health. 

"As a result of limited evidence, health plans and care guidelines set potentially restrictive treatment standards."

The National Quality Forum defined six months as the minimum duration of pharmacotherapy for opioid use disorder treatment. These measures are typically used by federal and state agencies to set treatment standards.

Researchers analyzed health insurance claims data to compare patients who continued buprenorphine treatment to those who discontinued six to nine months after initiating medication. The goal was to extend evidence from clinical trials. 

"Overall, our findings suggest a need for broader efforts to increase long-term access to care and extend standards and guidelines for minimum treatment duration," stated Samples. "While guidelines can lead to improvements in care and patient outcomes, they can also have unintended consequences, such as forming the basis for managed care practices that limit access to longer-term treatment."

Data from the National Institute of Drug Abuse (NIH) showed that every day, 128 people in the US die due to overdose, misuse of, and addiction to opioids, including prescription pain relievers, heroin, and synthetic opioids such as fentanyl.

The CDC also estimated that the total "economic burden" of prescription opioid misuse alone in the US is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice.

Although the opioid crisis continues to be a challenge in the US, access to opioid care is not as accessible as it should be. 

Last year, a study published in the Annals of Internal Medicine found that patients seeking buprenorphine faced challenges accessing treatment even when they lived in a state with a significant opioid crisis. 

Researchers made two separate phone calls to healthcare providers using a “secret shopper” methodology. They acted as a patient without insurance coverage and as a patient with Medicaid coverage and found that buprenorphine access was difficult, regardless of insurance status.

The calls were made to 546 providers in regions in which the opioid crisis is especially prominent, such as Massachusetts, New Hampshire, West Virginia, Ohio, and Washington DC. 

“We were surprised to find roadblocks at every step of the process of getting buprenorphine, from finding a clinic with any prescribed to finding one that will take public insurance,” said Michael Barnett, assistant professor of health policy and management at Harvard Chan School.