Buprenorphine discontinuation ups risk of overdose, acute care service use

Regardless of treatment duration, discontinuation of long-term buprenorphine heightens the risk of acute care service use and overdose in adults with opioid use disorder, reports a study.

“Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months,” the investigators said.

This retrospective longitudinal cohort analysis used the MarketScan multistate Medicaid claims database (2013–2017), covering 12 million beneficiaries annually. Adults (aged 18–64 years) who received buprenorphine continuously for ≥180 days by cohorts retained for 6–9 months, 9–12 months, 12–15 months and 15–18 months were included.

Assessment of outcome in the postdiscontinuation period required patients to be continuously enrolled in Medicaid for 6 months following buprenorphine cessation. Primary adverse outcomes were as follows: all-cause emergency department (ED) visits, all-cause inpatient hospitalizations, opioid prescriptions and drug overdose (opioid or nonopioid).

Adverse events were common across all cohorts. Nearly half of the patients (42.1–49.9 percent) visited the ED at least once.

Patients retained on buprenorphine for 15–18 months (n=931) vs 6–9 months (n=4,126) had a significantly lower likelihood of visiting the ED (odds ratio [OR], 0.75, 95 percent confidence interval [CI], 0.65–0.86), filling opioid prescriptions (OR, 0.67, 95 percent CI, 0.56–0.80) and inpatient hospitalizations (OR, 0.79, 95 percent CI, 0.64–0.99) in the 6 months following discontinuation.

Across all cohorts, about 5 percent of patients had one or more medically treated overdoses.

“Superior outcomes became significant with treatment duration beyond 15 months, although rates of the primary adverse outcomes remained high,” the investigators said.