Does Extended Release Buprenorphine Improve Treatment Retention Compared with Other Medications for Opioid Use Disorder?

Despite robust evidence of the efficacy of medications for opioid use disorder (MOUD), retention in treatment remains poor, with more than half of patients discontinuing pharmacotherapy in the first year. In 2017, the FDA approved monthly extended-release depot buprenorphine (XR-BUP), which may be more convenient for patients than daily sublingual buprenorphine. Researchers used a nationally representative data set of 27 million commercially insured individuals to describe rates of discontinuing XR-BUP compared with other MOUD during 2018.

• In this cohort, 14,358 individuals initiated MOUD: 12,171 (85%) received sublingual buprenorphine, 1173 (8%) extended-release naltrexone, 810 (6%) methadone, and 204 (1%) XR-BUP.
• Three months after initiation, the rates of treatment discontinuation were: 34% of patients receiving sublingual buprenorphine, 50% of those receiving XR-BUP, 58% of those receiving methadone, and 65% of those receiving extended-release naltrexone. The rate of discontinuation of XR-BUP was significantly higher than that of sublingual buprenorphine.
• Uptake of XR-BUP increased as the year progressed, and clinicians broadly adhered to dosing guidelines for XR-BUP (2 monthly doses of 300 mg followed by 100 mg doses).

Comments: Although these findings may not generalize to publicly insured or uninsured patients, they demonstrate that treatment retention remains a stubborn obstacle for people with OUD, despite the promise of XR-BUP. Future research will need to explore whether alternative dosing—such as providing higher doses of XR-BUP, or supplementing it with sublingual buprenorphine—improves retention.

Ashish Thakrar, MD* and Darius A. Rastegar, MD

* Contributing editorial intern and addiction medicine fellow, Johns Hopkins Bayview Medical Center

Reference: Morgan JR, Walley AY, Murphy SM, et al. Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort. Drug Alcohol Depend. 2021;225:108764.