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Access barriers, medication acceptability hinder long-term buprenorphine use

Only about 10% of participants with opioid use disorder used buprenorphine treatment over a 2-year follow-up period mainly due to issues with access and acceptability, according to data from a long-term follow-up study.

“Individuals have attributed discontinuation of buprenorphine to lack of knowledge, opioid craving and withdrawal symptoms, poor social support and the experience that buprenorphine works ‘too well’ such that euphoric effects of illicit opioid use cannot be felt,” Elizabeth A. Evans, PhD, of University of Massachusetts Amherst, and colleagues wrote in Journal of Substance Abuse Treatment. “Much less is known about contextual forces that influence access to buprenorphine for individuals with [opioid use disorder].”

Using random-intercept modeling, Evans and colleagues examined factors linked to long-term buprenorphine treatment use over a 24-month period in 789 individuals with opioid use disorder who had participated in a multi-site randomized clinical trial comparing buprenorphine and methadone. Participants reported receipt of any prescribed buprenorphine-naloxone over 2 years after the first follow-up as well as barriers to accessing buprenorphine treatment and any negative attitudes towards buprenorphine medication.

After adjusting for covariates, the researchers found that about 9.3% to 11.2% of participants used buprenorphine treatment over the 2-year follow-up.

Analysis indicated that patients with opioid use disorder who reported buprenorphine to be both accessible and acceptable were most likely to use buprenorphine over the follow-up, while those who reported buprenorphine to be unacceptable were least likely to use buprenorphine, even if they reported easy access to the medication. Specifically, more than half of participants reported they had a problem getting buprenorphine when needed because, most commonly, it wasn't accessible or affordable, according to a press release.

Of those who disliked buprenorphine and were not taking it, the findings showed that nearly 73% reported that negative physical reactions were the reason for not taking it, and among those not taking buprenorphine and were unwilling to take it, more than 54% reported it was because they were not using opioids now.

In addition, the researchers found that buprenorphine use was negatively linked to Hispanic ethnicity, West coast context and time receiving methadone treatment and incarceration during follow-up.

"Patients and families still have that expectation that short-term treatment is what they should get and want. But they need to have more realistic expectations and understand that long-term treatment is often necessary,” Evans said in a press release. "The good news is that buprenorphine is effective, but only if patients take it. We need to help patients access and use medication that will help them avoid a return to opioid use." – by Savannah Demko

Disclosures: One author reports royalties as an editor for UpToDate and honorarium from Alkermes, Inc. No other authors report any relevant financial disclosures.