Implementation opportunities for optimizing retention on buprenorphine treatment for people with opioid use disorder...

West Virginia leads the U.S. in overdose-related deaths, which can be decreased through buprenorphine treatment of opioid use disorder. Expanding buprenorphine benefits requires retaining patients in treatment. We explored prescribing real-world practices that affect retention.

We analyzed data from the West Virginia Prescription Drug Monitoring Program for individuals newly initiating buprenorphine in 2022. The primary outcome was time to treatment discontinuation. Baseline covariates included age, sex, and payment method. Dosage and days supplied were assessed at baseline to evaluate treatment initiation practices and as time-dependent measures to examine longitudinal patterns. Proportional hazards models with gamma frailty were used to estimate adjusted hazard ratios (aHRs).

The 6686 individuals who initiated buprenorphine were in their late thirties (mean 37.8 years) and mostly male (54.3 %). Relative to lower initial dosages (<8mg) and a shorter initial supply (<7 days), higher initial dosages of 8-15mg (aHR=0.75, 95 %CI:0.68-0.82) and ≥ 16mg (aHR=0.67, 95 %CI:0.61-0.74) and longer initial prescription of 7-13 days (aHR=0.75; 95 %CI:0.68-0.81), 14-27 days (aHR=0.43; 95 %CI:0.35-0.52) and, especially ≥ 28 days (aHR=0.31; 95 %CI:0.26-0.37), significantly reduced discontinuation risk (p < 0.001). In the time-dependent models with dosages and days of medication supplied changing over time, the protective effect significantly increased for higher dosages (≥16mg: aHR=0.45; 95 %CI:0.40-0.50) and number of days supplied (≥28 days: aHR=0.10; 95 %CI:0.10-0.11), p < 0.0001. Discontinuation was higher for younger persons, males, and those paying out-of-pocket; public insurance reduced the risk.

Higher buprenorphine doses and extended take-home dosing substantially improved retention, especially at initiation. To combat West Virginia's opioid crisis, clinicians should adjust prescribing practices accordingly.