REVIEW OF: Hasan MM et al, Am J Drug Alcohol Abuse 2022;48(4):481–491

STUDY TYPE: Retrospective analysis 

Of the three FDA-approved medications for the treatment of opioid use disorder (OUD), buprenorphine holds particular promise given its efficacy, ease of use, and ability to be prescribed in nonspecialist office settings. While the host of positive outcomes associated with its use give us plenty of reasons to start buprenorphine, much less work has been done around when, and if, it is safe to stop. We all have been asked by patients starting buprenorphine, “Do I have to take this medication forever?” The work here gives us some more data to help answer that question.

Researchers at the CDC and the Massachusetts Department of Public Health conducted a retrospective, longitudinal study of 2,572 patients with OUD who were prescribed buprenorphine. They divided patients into four groups: poor adherence, good adherence for <6 months, good adherence for 6–12 months, and good adherence for >12 months. Because the researchers were particularly interested in how patients did over the long term, they chose to examine time points 12 months after treatment discontinuation and 36 months after treatment initiation. The primary outcomes were all-cause hospitalization and emergency department (ED) visits.

The results were clear: Longer buprenorphine treatment was associated with fewer ED visits and fewer hospitalizations. Relative to the patients with good adherence for >12 months, the odds of hospitalization at 36 months following treatment initiation were 1.42 (1.09–1.82, p<.01) among patients with good adherence for 6–12 months, 1.83 (1.49–2.24, p<.001) among patients with good adherence for <6 months, and 2.71 (2.10–3.51, p<.001) among patients with poor adherence. Similarly, relative to patients with good adherence for >12 months, the odds of needing an ED visit 36 months after starting treatment were 1.30 (1.01–1.71, p<.01) among patients with good adherence for 6–12 months, 1.51 (1.22–1.87, p<.001) among patients with good adherence for <6 months, and 2.71 (1.30–2.19, p<.001) among patients with poor adherence.

The trends were similar when authors examined patients 12 months after treatment discontinuation.

CARLAT TAKE 

As far as we know, there is no safe time to stop buprenorphine, or any other MOUD for that matter. But this study suggests that, at least within the first year of treatment, longer treatment duration is associated with better outcomes. So encourage your patients to stay on buprenorphine once they’ve started it.