Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort.
Open accessAbstract
Background and aims While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort.Setting United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone.Measurements Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose.Findings We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment.Conclusions Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.
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A study of commercially insured individuals found lower retention on treatment for extended-release buprenorphine compared with other forms of MOUD among persons who had initiated extended-release buprenorphine within 13 months after FDA approval.
“In addition, a study of commercially insured individuals focusing on persons who had initiated extended-release buprenorphine within 13 months after FDA approval found lower retention on treatment for extended-release buprenorphine compared with other forms of MOUD.12,13”
From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [12]
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References 44 · Cited by 67
- Authors
- Morgan, J. R., Walley, A. Y., Murphy, S. M., Chatterjee, A., Hadland, S. E., Barocas, J., Linas, B. P., & Assoumou, S. A.
- Affiliations
- Boston University (US)
- Weill Cornell Medicine (US)
- Corresponding author
- Morgan, Jake R.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 225
- Pages
- 108764
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC8488795
- OpenAlex
- W3165477506
- Cited by
- 67
- References
- 44
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 13 · 2023: 16 · 2022: 5 · 2021: 1
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01046527)
- National Institute on Drug Abuse (K23DA044085, P30DA040500)
- National Center for Injury Prevention and Control (R01CE002999)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- extended-release buprenorphine, opioid use disorder, medication-assisted treatment, treatment discontinuation, treatment retention, extended-release naltrexone, methadone, commercially insured patients, opioid overdose epidemic, medication adherence
- MeSH terms
- Analgesics, Opioid, Buprenorphine, Delayed-Action Preparations, Humans, Methadone, Naltrexone, Opioid-Related Disorders, United States, Opiate Substitution Treatment
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