Emerging evidence suggests that opioid-dependent individuals prescribed lower doses of buprenorphine have a 20% greater likelihood of terminating their treatment compared to those administered higher doses. This revelation warrants a reexamination of the current buprenorphine dosage guidelines, particularly considering the widespread presence of the potent opioid fentanyl.
Researchers from Brown University have spearheaded a study advocating for an update to opioid addiction treatment strategies, particularly due to the prevalent influence of fentanyl in the current landscape.
The study, published recently in JAMA Network Open, focused on a patient pool from Rhode Island between 2016 and 2020. These years coincided with the significant proliferation of fentanyl, an extremely potent prescription opioid that has been implicated in escalating overdose rates and mortalities. The study was executed by a team of experts affiliated with Brown University, the National Institute on Drug Abuse, and the Rhode Island Department of Health.
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Dosage Parameters and Patient Outcomes
During the research period, 59% of individuals who began buprenorphine treatment for opioid misuse were administered a daily 16-milligram dose, and 53% of those on a 24-milligram dose discontinued their treatment within six months. Interestingly, the current daily dosage recommendation from the FDA is 16 milligrams. A comprehensive analysis between the two groups revealed that individuals receiving the FDA-recommended dosage were more inclined to stop treatment within six months compared to those on a 24-milligram dose.
It’s worth noting that the existing dosage recommendations were formulated prior to the prevalent spread of fentanyl. Researchers underscored the urgency of revisiting these guidelines in light of the evolving situation.
The Imperative of Modernized Treatment Protocols
Dr. Francesca Beaudoin, the study’s author and a professor of epidemiology and emergency medicine at Brown University, emphasized, “Treatment medications for opioid dependence, like buprenorphine, are life-saving but only effective if patients adhere to the regimen. Given that fentanyl is a recent complicating factor in the opioid crisis, it is critical that we revise and modernize treatment protocols. Otherwise, we are jeopardizing lives. Our study suggests that higher buprenorphine dosages are correlated with longer treatment adherence.”
Medications like buprenorphine can indeed be instrumental in reducing opioid cravings and withdrawal symptoms, contributing to successful long-term treatment. The researchers’ findings bolster the growing body of evidence supporting the safety and efficacy of administering buprenorphine doses higher than the currently recommended 16 milligrams, particularly in emergency and outpatient settings.
Fentanyl’s Impact and Existing Treatment Guidelines
In 2021, fentanyl was the primary cause in over 70,000 of nearly 107,000 reported overdose fatalities. Its potency is estimated to be 50 times greater than heroin. This has raised questions regarding the adequacy of current buprenorphine dosing guidelines to effectively counter the risks posed by such a formidable opioid.
“The presently advised target dosage for buprenorphine was based on studies conducted before fentanyl became prevalent,” said Dr. Rachel Wightman, another study author and an associate professor at the Warren Alpert Medical School of Brown University. “Now, it’s evident that we’re dealing with individuals who have a higher level of opioid tolerance and dependence, and our data indicate that elevated buprenorphine dosages could improve retention in treatment.”
Previous Findings and Future Research
For the study, the investigators retrospectively analyzed data from 6,499 Rhode Island residents who initiated buprenorphine treatment for opioid use disorder between 2016 and 2020. The aim was to gauge the association between daily buprenorphine dosage and treatment retention over a six-month period, which is in alignment with the minimum treatment duration set by the U.S. Centers for Medicare and Medicaid Services for measuring treatment continuity for opioid use disorder.
Most participants were male, between the ages of 25 and 44, and were either privately insured or covered by Medicaid. At the initiation of treatment, about 21% were given an 8-milligram dose, 50% a 16-milligram dose, and 10% a 24-milligram dose.
The researchers have plans to extend the scope of this study. They intend to conduct a clinical trial aimed at assessing the effectiveness of daily buprenorphine doses up to 24 milligrams in enhancing treatment adherence and reducing overdose and mortality risks. The trial will also consider other variables, such as clinician prescribing habits and patient socio-demographics, that could influence treatment retention. The outcomes could serve as the basis for revising existing standards for opioid use disorder treatment.
Reference: “Buprenorphine Dose and Time to Discontinuation Among Patients With Opioid Use Disorder in the Era of Fentanyl” by Laura C. Chambers, et al., 18 September 2023, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.34540
The research was financially supported by the National Institute on Drug Abuse, a division of the National Institutes of Health, under award number UG3DA056880. The content is solely the responsibility of the authors and does not necessarily reflect the official viewpoints of the National Institutes of Health.
Frequently Asked Questions (FAQs) about Buprenorphine Dosage Guidelines
What is the main focus of the research study discussed in the article?
The primary focus of the research is to examine the impact of buprenorphine dosages on treatment retention rates among individuals with opioid use disorder. The study particularly emphasizes the need for a reevaluation of current dosing guidelines in light of the increasing prevalence of fentanyl.
Who conducted the research and where was it published?
The research was led by experts from Brown University, the National Institute on Drug Abuse, and the Rhode Island Department of Health. It was published in JAMA Network Open.
What time period did the research cover, and from which location were the participants selected?
The study focused on patients from Rhode Island and covered the period from 2016 to 2020. This timeframe coincides with the rise of fentanyl, a potent prescription opioid.
What were the key findings of the study in terms of buprenorphine dosages?
The study found that individuals prescribed lower doses of buprenorphine were 20% more likely to discontinue their treatment within 180 days compared to those receiving higher doses. Specifically, more people prescribed the FDA-recommended dose of 16 mg discontinued treatment compared to those prescribed 24 mg.
How has the emergence of fentanyl influenced the study’s recommendations?
The rise of fentanyl, which is significantly more potent than other opioids, has led the researchers to call for a reevaluation of current buprenorphine dosage guidelines. The existing guidelines were established before fentanyl became widespread, and the situation now necessitates an update.
What is the FDA’s current recommended daily dosage of buprenorphine?
The FDA currently recommends a daily buprenorphine dosage ranging from 4 to 24 milligrams, with a target dose of 16 milligrams for most patients.
What are the future plans of the research team?
The researchers plan to initiate a clinical trial to evaluate the efficacy of daily buprenorphine doses of up to 24 mg. This will also include an investigation into other factors that may affect treatment retention such as clinician prescribing practices and patient socio-demographics.
Who funded the research?
The research was funded by the National Institute on Drug Abuse, part of the National Institutes of Health. The content of the study is solely the responsibility of the authors.
What is the significance of updating opioid use disorder treatment guidelines?
According to the researchers, updating treatment guidelines is crucial for addressing the current opioid crisis effectively. Without reevaluation, there is a risk of putting lives in jeopardy, particularly given the increasing prevalence of potent opioids like fentanyl.
More about Buprenorphine Dosage Guidelines
- JAMA Network Open
- National Institute on Drug Abuse
- FDA Guidelines on Buprenorphine
- Centers for Medicare and Medicaid Services
- Brown University Research
- Opioid Overdose Crisis
- Rhode Island Department of Health
- National Institutes of Health Funding
5 comments
So if I get this right, the study says higher doses could be more effective, right? Makes u wonder why it took so long to figure this out with the opioid crisis being what it is.
Shouldn’t we also look at other variables? The article talks about a clinical trial to explore other factors. I’m curious what else contributes to people leaving treatment. Is it just the dosage or are there other issues we’re not seeing yet?
Wow, this is eye-opening. Didn’t realize how big a role the dose plays in whether folks stick to the treatment or not. It’s high time the FDA relooks at the guidelines, especially with fentanyl on the rise.
this is crucial information. I lost a friend to an opioid overdose, and honestly, it makes me think. Could a higher dose of buprenorphine have made a difference? Its time for change, seriously.
Just read this, and I gotta say I’m not surprised. We need to constantly update our medical guidelines to adapt to new challenges. The opioid crisis ain’t getting any better, and it’s alarming that our treatment protocols may be outdated.