Buprenorphine treatment gaps linked to increased overdose risk, higher care spending

Nonadherence to treatment with buprenorphine is associated with an increased risk of opioid overdose as well as increased spending for health care among Medicare participants, according to a study published in JAMA Psychiatry.

“Previous research has found that at least 80% adherence to buprenorphine is needed to reduce the risk of relapse with opioids than can result in overdose,” Jason B. Gibbons, PhD, of the department of health policy and management at Johns Hopkins University Bloomberg School of Health, and colleagues wrote. “But issues such as poor treatment access and patient preferences can reduce adherence.”

Gibbons and colleagues sought to estimate the association between buprenorphine treatment gaps, opioid overdose and health care spending.

Their longitudinal case-control study compared patient opioid overdose and health care spending in buprenorphine-treated months with treatment gap months. A total of 34,505 U.S. Medicare fee-for-service beneficiaries (52% male, mean age 49.5) diagnosed with opioid use disorder who received at least one 2-week period of continuous buprenorphine treatment between 2010 and 2017 were included. The number of opioid overdoses and total, medical and drug spending (combined patient out-of-pocket and Medicare spending) were considered, as was a gap in buprenorphine treatment in a given month lasting more than 15 consecutive days.

Results showed that 11,524 Medicare beneficiaries (33.4%) experienced one or more buprenorphine treatment gaps. Beneficiaries were 2.89 (95% CI, 2.20-3.79) times more likely to experience an opioid overdose during buprenorphine treatment gap months compared with treated months.

During treatment gap months, spending was $196.41 (95% CI, $110.53-$282.30) more than in treated months. Patients who continued to take buprenorphine dosages of greater than 8 mg/d and 16 mg/d were 2.61 and 2.84 times more likely to overdose in a treatment gap month, respectively, while patients taking buprenorphine dosages of 8 mg/d or less were 3.62 times more likely to overdose in a treatment gap month (maintenance of >16 mg/d: HR, 2.64 [95% CI, 1.80-3.87]; maintenance of >8 mg/d: HR, 2.84 [95% CI, 2.13-3.78]; maintenance of 8 mg/d: HR, 3.62 [95% CI, 1.54-8.50]).

“Patients with treatment gaps had opioid overdose rates 1.56 to 4.3 times higher compared with treated months and had $86.37 to $366.06 higher health care expenditures,” Gibbons and colleagues wrote.