Overdose, Relapse After Buprenorphine Discontinuation High

Buprenorphine treatment may be needed for several years after an opioid overdose to reduce the risk of overdose and other adverse events, according to a study published online December in The American Journal of Psychiatry.

Arthur Robin Williams, M.D., from the New York State Psychiatric Institute at the Columbia University Medical Center in New York City, and colleagues used the MarketScan multistate Medicaid claims database (2013 to 2017) to identify adults (18 to 64 years of age) who received buprenorphine continuously for ≥180 days. Outcomes were assessed by buprenorphine duration period (six to nine months, nine to 12 months, 12 to 15 months, and 15 to 18 months).

The researchers found that adverse events were common across all cohorts, and almost half of patients (42.1 to 49.9 percent) were seen in the emergency department at least once. Patients retained for 15 to 18 months (931 patients) had significantly lower odds of emergency department visits (odds ratio, 0.75), inpatient hospitalizations (odds ratio, 0.79), and filling opioid prescriptions (odds ratio, 0.67) in the six months following discontinuation, compared to patients retained on buprenorphine for six to nine months (4,126 patients). Across cohorts, approximately 5 percent of patients experienced one or more medically treated overdoses.

"Patients and families need guidance, social support, and better coordination of care to help facilitate long-term maintenance with buprenorphine for opioid use disorder," Williams said in a statement.

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