Predictors and Processes of Early Buprenorphine Discontinuation: Study Protocol

Buprenorphine and other medications for opioid use disorder are recommended as standard of care and associated with positive health and addiction-related outcomes. Although observational research suggests at least 180 days of continuous buprenorphine therapy as a measure of treatment quality, more than 50% of patients discontinue before this time period. The drivers of early discontinuation have not been well studied. Prior research, largely utilizing retrospective administrative data, has identified demographic and clinical correlates of discontinuation, including polysubstance use, younger age, minoritized race or ethnicity, male birth sex, higher pain interference and low buprenorphine dose, but why or how such factors are linked with early discontinuation remains unknown. This prospective cohort study will use a convergent parallel mixed methods design to obtain administrative, quantitative survey and qualitative interview data addressing early buprenorphine discontinuation. We will enroll a national sample of N = 965 veterans initiating buprenorphine, stratifying recruitment by sex, race/ethnicity and rurality and collect longitudinal quantitative surveys at baseline, 6 and 12 months to identify modifiable barriers to treatment retention and learn about participant experiences sustaining versus discontinuing buprenorphine. Electronic health record data supplemented by medical record review will identify provider- and system-level factors associated with early discontinuation. Qualitative interviews with a subset of discontinuing participants and their buprenorphine-prescribing clinicians will identify motivations for, and experiences with, discontinuation and contextualize results from surveys and medical record review. This study will provide key information from which to develop interventions targeting the modifiable causes of early buprenorphine discontinuation.