BACKGROUND: Buprenorphine maintenance treatment of opioid dependence requires individualized dosing. Treatment guidelines and product labeling suggest optimal dosing will be in the range of 12-24 mg/day, after titration, for most patients. OBJECTIVE: To examine real-world buprenorphine dosing patterns among opioid dependent patients.
METHODS: Patients of any age with ≥1 buprenorphine outpatient pharmacy claim were selected from the MarketScan Commercial and Medicaid databases (2008-2014). The date of the earliest claim was the index date. Patients were required to have no claims for buprenorphine in the 3 months pre-index, a claim with a diagnosis of opioid dependence prior to or on the index date, and continuous enrollment with medical and pharmacy benefits 6 months pre- and post-index. Buprenorphine average daily dose was calculated from all buprenorphine claims in the first 6 months post-index. Patient and clinical characteristics were examined during a 6 month pre-index period and compared by dose groups.
RESULTS: A total of 22,563 Commercial and 7,811 Medicaid patients were included in the study. In the Commercial sample, 39% of patients received an average daily dose of buprenorphine <12 mg, 57% received 12-24 mg, and 4% received >24 mg. In the Medicaid sample, 24% received <12 mg/day, 70% received 12-24 mg/day, and 6% received >24 mg/day. In both the Commercial and Medicaid samples, higher rates of baseline alcohol use disorder, substance use disorder (other than opioids), schizophrenia, and depressive disorders were observed in those receiving <12 mg/day compared to the patients receiving 12-24 mg/day (all P<0.05). Consistent with the comorbidities observed, patients receiving <12 mg/day had significantly higher use of sedative/hypnotics, antidepressants, and antipsychotics than those receiving 12-24 mg/day. Commercial patients receiving <12 mg or >24 mg had higher use of narcotic pain medication than those dosed at 12-24 mg while those receiving >24 mg had higher rates of benzodiazepine and sedative/hypnotic use than those receiving 12-24 mg (all P<0.05), but this was not observed in the Medicaid sample.
CONCLUSIONS: The majority of patients with opioid use disorder received 12-24 mg/day of buprenorphine, but about one-fourth of Medicaid and one-third of Commercial patients received lower doses. Higher rates of mental health comorbidities were observed in patients receiving lower doses. Future research is needed to assess if these patients are being underdosed or optimally treated.
