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Buprenorphine for opioid dependence may improve treatment adherence for depression
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Patients receiving buprenorphine for treatment of opioid use disorder were more likely to use medications for unrelated, chronic conditions like depression, a study published in Medical Care revealed.
“Given the increasing buprenorphine use for [medications for addiction treatment] and the prevalence of chronic diseases among individuals with [opioid use disorder], it is important to understand what kind of impact the buprenorphine treatment has on the treatment of unrelated, chronic conditions,” Hsien-Yen Chang, PhD, from the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote.
In a retrospective cohort study, researchers quantified the effect of buprenorphine treatment on adherence to five therapeutic classes — antilipids, antipsychotics, antiepileptics, antidiabetics and antidepressants — among commercially ensured patients with opioid use disorder using Truven Health’s MarketScan data.
The investigators examined two daily indicators — having buprenorphine and having chronic medication on hand for each therapeutic class — within the 6-month period after initiating buprenorphine, then used logistic regression to determine the link between these indicators. Analysis was adjusted for demographics, morbidity and baseline adherence.
The study showed that the percentage of days with chronic medication was always higher on days where patients had buprenorphine on hand.
Chang and colleagues reported that buprenorphine use was associated with a higher likelihood of adherence to all chronic medication classes included in the analysis, especially antidepressants:
- antidepressants (OR = 1.42; 95% CI, 1.32-1.6);
- antilipids (OR = 1.27; 95% CI, 1.04-1.54);
- antiepileptics (OR = 1.22; 95% CI, 1.1-1.36);
- antipsychotics (OR = 1.16; 95% CI, 0.97-1.4); and
- antidiabetics (OR = 1.25; 95% CI, 0.93-1.79).
“Interestingly, the strongest association we identified was between buprenorphine initiation and treatment with antidepressants, which may reflect the greater experience of buprenorphine prescribers with the use of antidepressants, as well as a recognition of the important ways that untreated depression can interfere with adherence to unrelated conditions,” they wrote. “Our findings are of both clinical and economic importance because there is a large, and growing, population with [opioid use disorder] and a high burden of comorbid chronic somatic and psychiatric disease in this population.” – by Savannah Demko
Disclosures: Chang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Harshal Kirane, MD
In the context of treating opioid use disorder, buprenorphine is strongly associated with decreasing risk of continued drug use, overdose, suicide and death. Unfortunately, despite such compelling mental health and quality of life benefits, buprenorphine and other medication-assisted treatment options are widely underutilized. Chang and colleagues’ recent study suggests access to buprenorphine improves medication adherence in general. This is a new and meaningful benefit of buprenorphine treatment.
Addiction takes a complex toll on individuals and their families, and often accompanied by co-occurring psychiatric and medical illness. Poor medication adherence is a common challenge that requires innovative approaches. Buprenorphine’s potential impact on adherence underscores the important role it can play in a holistic approach to care.
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