Capturing the Full Range of Buprenorphine Treatment Response

Reliance on abstinence-based treatment success rules may fail to capture the full continuum of treatment response to buprenorphine plus medical counseling (BUP+MC) for opioid use disorder (OUD).

To describe patterns of reduction in illicit opioid use of patients both labeled as a success and nonsuccess based on an abstinent-based treatment outcome rule.

This study is a secondary data analysis of 4 harmonized randomized clinical trials on BUP+MC for OUD from multiple sites that included 869 patients with OUD. These data were analyzed on April 23, 2024. By week 12, 643 participants of the sample original remained (74%).

All studies included patients randomized to BUP+MC or BUP plus enhanced MC (eg, delivered with adjunctive cognitive behavioral therapy).

Weekly self-reported days of illicit opioid use through 12 weeks of treatment. Abstinence was confirmed by urine drug screen.

This study included 869 adults with OUD aged 18 to 69 (mean, 34.2 [SD, 10.45]) years; 287 patients were female (33%), 52 identified as Black (6%), 70 identified Hispanic (8%), 713 identified as White (82%), and 34 identified as other racial groups (4%). Only 377 patients (43%) would have been labeled a success using an abstinence-based success rule. However, the total sample reported a decrease from a mean baseline rate of illicit opioid use nearly every day (6.21 [SD, 1.50] days per week) to a mean of less than 1 day per week at week 12 (0.54 [SD, 1.28]). Importantly, even those who were labeled as nonsuccessful reported a substantial reduction in opioid use from a mean of 6.29 (SD, 1.42) days per week to 1.51 (SD, 1.76) days per week.

In this study, about half of patients receiving BUP+MC achieved near complete abstinence; however, many more experienced a partial treatment response characterized by a substantial reduction in illicit opioid use that falls short of abstinence. Future studies are needed to characterize how these reductions are associated with functional and long-term outcomes. Dissemination of BUP+MC as part of standard buprenorphine prescribing practices is an essential next step given the robust average response of this intervention.