Impact of Buprenorphine Dosage on the Occurrence of Relapses in Patients with Opioid Dependence

Abstract

<b><i>Objectives:</i></b> Buprenorphine (BUP) is used in opioid maintenance treatment (OMT) for opioid-dependent patients. Previous real-world evidence suggests that many patients receive lower BUP dosage than recommended, with 38% of patients receiving <6 mg BUP per day. The goal of this research is to evaluate the impact of BUP dosage on the risk of relapses in the real world. <b><i>Methods:</i></b> This study was based on German claims data of 4 million patients. Patients identified by International Classification of Diseases, 10th Edition F11.2 (opioid dependence) between 2011 and 2012 and at least one BUP prescription were selected for this study (<i>n</i> = 364) and followed up over 4 years. Patients were assigned to 6 dosage groups, with <6 mg/day serving as low dosage/reference category. The impact of dosage on the occurrence of relapses (indicated by treatment interruption of >3 months without OMT prescription or hospital admissions) was examined using multivariate logistic regression. Age, gender, comorbidities, fixed/variable dosing, and up-dosing were used as covariates. <b><i>Results:</i></b> Results showed a protective effect of higher BUP as higher BUP dosages were significantly associated with a lower risk of relapse. Using low dosage (<6 mg/day) as the reference category, ORs were 0.40 (95% CI 0.19–0.87) at 6–<8 mg/day, 0.28 (0.15–0.56) at 8–<10 mg/day, 0.26 (0.10–0.67) at 10–<12 mg/day, 0.40 (0.18–0.92) at 12–<16 mg/day, and 0.18 (0.09–0.37) at ≥16 mg/day. No covariate showed a significant effect on the probability of relapse. <b><i>Conclusions:</i></b> The present study used a large German health claims dataset to confirm that higher BUP dosages are a protective factor for avoiding relapses in opioid-dependent patients, thus highlighting the importance of adequate BUP dosing in relapse prevention.

Changing Pattern of Opioid Users Attending an Opioid Agonist Treatment Clinic in North India

“…Dosage lesser than 6 mg has been shown to have an increased risk for relapse as compared with a higher dosage. 24 Another study from India also reported a lower dosage of OST similar to the current study. 25 Another observation was a decreasing trend of comorbid substance use disorders like cannabis and alcohol.…”

“…Dosage lesser than 6 mg has been shown to have an increased risk for relapse as compared with a higher dosage. 24 Another study from India also reported a lower dosage of OST similar to the current study. 25…”

Pharmacokinetic-pharmacodynamic analysis of drug liking blockade by buprenorphine subcutaneous depot (CAM2038) in participants with opioid use disorder

“…However, numerous patient-level and structural factors, beyond pharmacological blockade, contribute to the overall response to OUD treatment [8]. Nevertheless, this study predicts BPN plasma concentrations above 0.4 ng/mL (simulated complete blockade threshold) or 0.675 ng/mL (IC 90 ) may confer desired clinical efficacy to effectively reduce drug liking, aligning with previous analyses of outpatient clinical studies and prescription claims data that found a dose-response in reduction of illicit opioid use [28,29]. Together, these findings indicate that a dose of at least 8 mg sublingual BPN may be needed to avoid relapse to drug use.…”

The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study

“…The elevated risk may be due to additional substance use, which may be driven by insufficient dosing. Alternatively, there is the possibility that this risk is due to central nervous system effects linked to the methadone dose being increased too rapidly (Baxter et al, 2013;Fareed et al, 2012;Reimer et al, 2020). Understanding these factors might reveal a role for additional symptomatic medication use during induction, or a need for revision of, or greater adherence to standard dosing protocols.…”