Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population
Open accessAbstract
We investigated prescribing patterns for four opioid use disorder (OUD) medications: 1) injectable naltrexone, 2) oral naltrexone, 3) sublingual or oralmucosal buprenorphine/naloxone, and 4) sublingual buprenorphine as well as transdermal buprenorphine (which is approved for treating pain, but not OUD) in a nationally representative claims-based database (Truven Health MarketScan®) of commercially insured individuals in the United States. We calculated the prevalence of OUD in the database for each year from 2010 to 2014 and the proportion of diagnosed patient months on OUD medication. We compared characteristics of individuals diagnosed with OUD who did and did not receive these medications with bivariate descriptive statistics. Finally, we fit a Cox proportional hazards model of time to discontinuation of therapy as a function of therapy type, controlling for relevant confounders. From 2010 to 2014, the proportion of commercially insured individuals diagnosed with OUD grew by fourfold (0.12% to 0.48%), but the proportion of diagnosed patient-months on medication decreased from 25% in 2010 (0.05% injectable naltrexone, 0.4% oral naltrexone, 23.1% sublingual or oralmucosal buprenorphine/naloxone, 1.5% sublingual buprenorphine, and 0% transdermal buprenorphine) to 16% in 2014 (0.2% injectable naltrexone, 0.4% oral naltrexone, 13.8% sublingual or oralmucosal buprenorphine/naloxone, 1.4% sublingual buprenorphine, and 0.3% transdermal buprenorphine). Individuals who received medication therapy were more likely to be male, younger, and have an additional substance use disorder compared with those diagnosed with OUD who did not receive medication therapy. Those prescribed injectable naltrexone were more often male, younger, and diagnosed with additional substance use disorders compared with those prescribed other medications for opioid use disorder (MOUDs). At 30 days after initiation, 52% for individuals treated with injectable naltrexone, 70% for individuals treated with oral naltrexone, 31% for individuals treated with sublingual or oralmucosal buprenorphine/naloxone, 58% for individuals treated with sublingual buprenorphine, and 51% for individuals treated with transdermal buprenorphine discontinued treatment. In the Cox proportional hazard model, use of injectable naltrexone, oral naltrexone, sublingual buprenorphine, and transdermal buprenorphine were all associated with significantly greater hazard of discontinuing therapy beginning >30days after MOUD initiation (HR=2.17, 2.54, 1.15, and 2.21, respectively, 95% CIs 2.04-2.30, 2.45-2.64, 1.10-1.19, and 2.11-2.33), compared with the use of sublingual or oralmucosal buprenorphine/naloxone. This analysis demonstrates that the use of evidence-based medication therapies has not kept pace with increases in OUD diagnoses in commercially insured populations in the United States. Among those who have been treated, discontinuation rates >30days after initiation are high. The proportion treated with injectable naltrexone, oral naltrexone, and transdermal buprenorphine grew over time but remains small, and the discontinuation rates are higher among those treated with these medications compared with those treated with sublingual or oralmucosal buprenorphine/naloxone. In the face of the opioid overdose and addiction crisis, new efforts are needed at the provider, health system, and policy levels so that MOUD availability and uptake keep pace with new OUD diagnoses and OUD treatment discontinuation is minimized.
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Access to and uptake of MOUD has risen, but the increase has not been substantial enough to reverse the trajectory of opioid overdose-related death rates.
“Although access to and uptake of MOUD has risen, the increase has not been substantial enough to reverse the trajectory of opioid overdose–related death rates.7,8”
From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [7]
The Results report that MOUD prescription-months rose 156% from 2010 to 2014 among commercially insured people with OUD, while the proportion of their person-time on medication fell from 25% to 16%. The Introduction describes an epidemic of overdose deaths, but the paper does not assess whether MOUD uptake reversed—or failed to reverse—the trajectory of overdose death rates. It also does not directly measure access to MOUD. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMedication treatment for OUD remains underutilized.
“it remains underutilized”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [51]
Patients often drop out of medication treatment for OUD.
“patients often drop out of medication treatment [50, 51].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [51]
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Self-citation
- Authors
- Morgan, J. R., Schackman, B. R., Leff, J. A., Linas, B. P., & Walley, A. Y.
- Affiliations
- Boston Medical Center (US)
- Weill Cornell Medicine (US)
- Boston University (US)
- Corresponding author
- Morgan, Jake R.
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 85
- Pages
- 90-96
- ISSN
- 0740-5472 (ISSN-L)
- PMC
- PMC5750108
- OpenAlex
- W2729232923
- Cited by
- 332
- References
- 25
- Citations by year
- 2026: 17 · 2025: 39 · 2024: 35 · 2023: 43 · 2022: 48 · 2021: 48 · 2020: 46 · 2019: 37 · 2018: 14 · 2017: 4
- FWCI
- 25.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Substance Abuse Treatment (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (P30DA040500, R01DA031059)
- 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
- opioid use disorder, injectable naltrexone, oral naltrexone, buprenorphine/naloxone, sublingual buprenorphine, transdermal buprenorphine, drug discontinuation, prescribing patterns, commercially insured patients, time to discontinuation
- MeSH terms
- Buprenorphine, Naloxone Drug Combination, Assessment of Medication Adherence, Adult, Age Factors, Analgesics, Opioid, Buprenorphine, Drug Administration Routes, Female, Humans, Insurance Claim Review, Male, Naltrexone, Narcotic Antagonists, Opioid-Related Disorders, Practice Patterns, Physicians', Sex Factors, United States, Prevalence, Drug Monitoring, Medication Adherence
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