People taking buprenorphine to overcome opioid use disorder (OUD) aren’t using the medication-assisted treatment (MAT) drug for long enough, according to a new study published Wednesday in the Journal of Substance Abuse Treatment.
Buprenorphine has been successfully used to treat OUD for nearly 20 years. The drug has been shown to lead to sustained recovery and reduced mortality, especially when patients take it for long periods. However, most buprenorphine users aren’t doing that, the study suggests.
While minimum care guidelines recommend 180 days of treatment, only 37% of buprenorphine users in Washington state hit that target during their first episode of care. Most opioid users dropped out of treatment about 84 days into their first buprenorphine episode, researchers found.
On the bright side, though, the majority of those patients came back for additional care, indicating that it takes a few tries before buprenorphine treatment sticks.
“We knew anecdotally it takes multiple tries for people; this paper proves that,” Caleb Banta-Green, the study’s lead author, told Behavioral Health Business. “That’s important because I’ve worked with clinics before that say, ‘This is a limited resource so … we’re not going to take people who have failed before.’”
But the research indicates those sorts of policies are misguided. Instead, the findings suggest payers and providers should implement rules that assume most patients will require multiple MAT attempts before finding success.
The study dug into data from Washington state’s prescription monitoring program from 2012 to 2019, zeroing in on more than 25,000 residents who were prescribed buprenorphine during that period. Despite the single-state focus, the study could have national implications, according to Banta-Green, who is also the principal research scientist at the Addictions, Drug & Alcohol Institute at the University of Washington School of Medicine.
“Any state could do this with their prescription monitoring program data,” Banta-Green said. “The other piece that’s really important is this is the total population — this is everybody in Washington State. All 7 million people were eligible to be in this study because it’s the prescription monitoring program.”
When the study’s authors looked at the total amount of time Washington-based buprenorphine users spent in care across all episodes, they found that the median cumulative time for a patient in treatment was 195 days. While that’s more than the recommended 180 day care minimum, it’s still not enough, according to Banta-Green.
“I’ve known people who’ve been successful on buprenorphine, and they’ve stayed on it for a decade,” he said. “I’m not saying everybody needs to do that, but when I talk with clinicians, … what I generally hear is that, if [they] have a person doing well on buprenorphine, [they’ll] probably do a check in at one or two years to talk about whether or not they want to continue — not at six months.”
The longer patients spend in treatment, the better outcomes they have in most cases, he added. As such, policymakers, payers and providers should account for that.
“It’s really important that … states … and MCO’s are using [this sort of data] with their providers,” Banta-Green said. “And even start incentivizing: ‘We really want to encourage that at least half of the people are on for a year’ or something like that.”
He went on to encourage providers to discuss various medication and treatment options with MAT patients to give them more control in their care journey, as well as to make medication available to patients upon their first visit. He has more resources available for providers and clinicians at UW’s Addictions, Drug & Alcohol Institute website, www.learnabouttreatment.org.