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Association between high-threshold practices and buprenorphine treatment termination.

Valencia Lyle1, Samantha Harris2, Omeid Heidari3

  • 1Bureau of Community and Health Systems, Michigan Department of Licensing and Regulatory Affairs, 611 W. Ottawa St, Lansing, MI 48909, USA.

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|January 17, 2024
PubMed
Summary

High-threshold buprenorphine treatment practices, such as frequent drug testing and mandatory counseling, are associated with increased treatment termination rates for opioid use disorder. Minimizing these barriers is crucial for improving patient retention and addressing the overdose crisis.

Keywords:
Behavioral health careBuprenorphineDrug policyHigh-threshold treatmentOpioid use disorder

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Area of Science:

  • Addiction Medicine
  • Public Health Policy
  • Pharmacotherapy

Background:

  • Buprenorphine treatment for opioid use disorder (OUD) often includes frequent drug testing and counseling requirements.
  • State policies frequently mandate these high-threshold practices, impacting treatment accessibility.

Purpose of the Study:

  • To investigate the relationship between specific counseling and drug testing protocols and buprenorphine treatment discontinuation.
  • To inform policy changes regarding OUD treatment standards in Michigan.

Main Methods:

  • A survey was administered to 377 buprenorphine prescribers in Michigan.
  • The survey collected data on prescriber practices regarding counseling and drug testing frequency.

Main Results:

  • Prescribers requiring drug testing at every visit were 38% more likely to terminate treatment compared to those with less frequent or no testing.
  • Prescribers mandating counseling showed a 33% higher likelihood of treatment termination than those without such requirements.

Conclusions:

  • High-threshold practices in buprenorphine treatment, including frequent drug testing and mandatory counseling, are linked to increased treatment termination.
  • Eliminating the DEA X-waiver necessitates policy adjustments to reduce these barriers and enhance treatment continuity for OUD.