Higher Buprenorphine Dose in First Month of Treatment for OUD Associated with Decreased Mortality

Buprenorphine is a life-saving treatment for opioid use disorder (OUD). This observational study investigated the relationship between average daily transmucosal buprenorphine dose (categorized as: ≤8 mg, >8 to ≤16 mg, >16 mg) in participants’ first 30 days of treatment and subsequent one-year opioid-involved overdose and other-cause mortality. Data were extracted from the Kentucky prescription drug monitoring program and state death records, January 2017–November 2019.

  • The sample included 49,857 patients with 227 opioid-involved overdose deaths and 459 deaths from other causes after one year.
  • Compared with the ≤8 mg cohort, the adjusted subdistribution hazard ratio (aSHR) of opioid-involved overdose deaths decreased by 55 percent in the >8 to ≤16 mg cohort and by 64 percent in the >16 mg cohort.
  • Compared with the ≤8 mg cohort, there was a decreased incidence in deaths from other causes observed in the >8 to ≤16 mg (aSHR, 0.78) and in the >16 mg (aSHR, 0.62) cohorts.

Comments: This study demonstrates an inverse relationship between buprenorphine dosing in the first month of treatment and opioid-involved overdose and other-cause mortality. These findings underscore the urgency of optimizing buprenorphine dosing and reducing regulatory restrictions around higher daily buprenorphine doses, especially within the first month of treatment.

Emily Nields, DO

Reference: Lei F, Lofwall MR, McAninch J, et al. Higher first 30-day dose of buprenorphine for opioid use disorder treatment is associated with decreased mortality. J Addict Med. 2024;18(3):319–326.

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