Review of: Jakubowski A et al, J Subst Abuse Treat 2020;119:108140

Buprenorphine is a safe and effective treatment of opioid use disorder (OUD), but studies show that less than two-thirds of patients treated with buprenorphine are still in treatment 6 months later (Timko C et al, J Addict Dis 2016;35(1):22–35). Since the highest rate of dropout is during the first month of treatment, Jakubowski and colleagues decided to look at factors affecting dropout and hypothesized that the timing of the first dose of buprenorphine might be a decisive factor. The researchers speculated that patients receiving their first dose on their very first visit might be more likely to stay in treatment over time.

The investigators looked retrospectively at a cohort of 222 patients engaged in treatment in a federally qualified health center who were treated with buprenorphine. They divided them into two groups: those who were prescribed buprenorphine at the initial evaluation, and those who were prescribed buprenorphine later but within 30 days of the initial visit. Treatment consisted of buprenorphine prescription plus visits with a primary care physician every 1–2 weeks until stable, then monthly.

Of the 222 patients, 89 (40%) were prescribed buprenorphine at the initial visit, and 133 patients (60%) were prescribed buprenorphine later but within the first 30 days. Eighty percent of patients remained in treatment through the first 30 days. A higher percentage (85% vs 77%) of same-day prescription receipt patients remained in treatment through the first 30 days, but this increase was not statistically significant (p = 0.11). It was noted that alcohol or benzodiazepine use was associated with delayed prescription of buprenorphine, but the results were the same even when these factors were adjusted out.

CATR’s Take
This retrospective study did not identify a statistically significant improvement in treatment retention associated with initiating buprenorphine on the first day of evaluation when compared with later initiation. On the other hand, early treatment did not show any sign of increasing dropout, and it should be emphasized as it may decrease overdose risk and be associated with other unmeasured benefits.