Risk of Oral Health Problems in Adults With Opioid Use Disorder Treated With Transmucosal Buprenorphine

In early 2022, based on limited case-report evidence, the US Food and Drug Administration warned about possible oral health problems associated with transmucosal (sublingual, buccal) buprenorphine formulations commonly used to treat opioid use disorder (OUD). The purpose of this study was to assess the risk of adverse oral health outcomes among adults prescribed transmucosal buprenorphine for OUD.

This retrospective cohort study utilizing TriNetX claims data consisted of adults diagnosed with OUD in 2002-2019, and who either filled ≥3 transmucosal buprenorphine prescriptions within any 6-month period (buprenorphine cohort) or did not fill any buprenorphine prescriptions (control cohort). Weighted propensity score matching and Cox proportional hazards regression were applied to evaluate the probability of new oral health problem diagnoses during the follow-up period, which lasted up to 5 years after the index date (ie, first buprenorphine prescription or first diagnosis of OUD date, respectively), with outcomes at 1 and 5 years serving as the main risk measures.

The study included 721,878 adults with OUD, with 156,594 (21.7%) in the buprenorphine cohort. Persons prescribed buprenorphine displayed a 1.24-1.30 higher adjusted risk of acquiring new oral health problem diagnoses both at 1- and 5-year follow-up ( P  < 0.001).

Our claims data-based results suggest associations between transmucosal buprenorphine use and developing oral health problems among adults with OUD, underscoring the importance of targeted prospective research as well as counseling patients about this potential risk and ways to mitigate it, without unnecessarily deterring patients from this evidence-based treatment.