Data suggest that many patients treated for opioid use disorder (OUD) with buprenorphine may receive lower doses than recommended. Using data from German health insurance claims, researchers assessed the impact of buprenorphine dosage on risk of return to opioid use.* Each patient with OUD identified in 2011 and 2012 and receiving buprenorphine (n=364) was followed for 4 years or until death. Buprenorphine dosage groups were: <6 mg/day (n=133), 6–<8 mg/day (n=40), 8–<10 mg/day (n=65), 10–<12 mg/day (n=27), 12–<16 mg/day (n=33), and ≥16 mg/day (n=66).
- Overall, 74% of the patients were male and the mean age was 34 years. The mean buprenorphine dose was 12.2 mg/day.
- 166 patients returned to opioid use during the study period.
- Patients receiving the lowest buprenorphine doses had the highest risk of return to use (64%).
- In analyses adjusted for age, gender, comorbidities, co-medication, fixed or variable dosing, up-dosing, and take-home/office-based prescription, there was a protective effect of higher buprenorphine doses on the risk of return to use:
- Compared with patients receiving the lowest doses (<6 mg/day), the odds ratios (ORs) of return to use for each dose level were: 0.40 at 6–<8 mg/day, 0.28 at 8–<10, 0.26 at 10–<12, 0.40 at 12–<16, and 0.18 at ≥16.
* Defined as either no opioid agonist treatment for >3 months and returning to opioid agonist treatment thereafter, or hospital stays with acute opioid intoxication.
Comments: This study found that higher buprenorphine doses were associated with a diminished risk of return to opioid use among people with OUD, highlighting the importance of adequate buprenorphine dosage in the treatment of this population.
Nicolas Bertholet, MD, MSc
Reference: Reimer J, Vogelmann T, Trümper D, Scherbaum N. Impact of buprenorphine dosage on the occurrence of relapses in patients with opioid dependence. Eur Addict Res. 2020;26(2):77–84.