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The association between buprenorphine doses above 16 milligrams and treatment retention in a multi‐payer national sample in the United States, 2014 to 2021.

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Title: The association between buprenorphine doses above 16 milligrams and treatment retention in a multi‐payer national sample in the United States, 2014 to 2021.
Authors: Stringfellow, Erin J., Dong, Huiru, Khatami, Seyedeh Nazanin, Lee, Hannah, Jalali, Mohammad S.
Source: Addiction. Jun2025, Vol. 120 Issue 6, p1198-1206. 9p.
Subjects: Substance abuse, Combination drug therapy, Research funding, Scientific observation, Treatment effectiveness, Descriptive statistics, Dose-effect relationship in pharmacology, Longitudinal method, Odds ratio, Naloxone, Confidence intervals, Buprenorphine, Evaluation
Geographic Terms: United States
Abstract: Background and Aims: Buprenorphine‐naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40 mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine‐naloxone doses between 4 and 40 mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40 mg doses. Design: Observational cohort study in a national, multi‐payer sample of prescription claims (IQVIA) of episodes involving buprenorphine‐naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180 days. New episodes started with a 14+ day gap between prescriptions. Setting: United States of America. Participants: The sample involved 620 229 episodes across 498 879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine‐naloxone for OUD. Measurements The exposure was the maximum daily dose of buprenorphine‐naloxone reached in the first 30 days of an episode, ranging from 4 to 40 mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18 months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation. Findings Daily doses of 24, 32 and 40 mg increased retention compared with 16 mg at 1–18 months [adjusted odds ratio (aOR) range = 1.17; 95% confidence interval (CI) = 1.14, 1.20 at 18 months to 1.52 (CI = 1.49, 1.54) at 1 month, both for 24 mg]. In pairwise comparisons, 32 mg was favorable to 24 mg at 6, 12 and 18 months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12 months; aOR = 1.12 (95% CI = 1.06, 1.19) at 18 months], and 40 mg was favorable to 24 mg at 12 and 18 months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months]. Conclusions: Daily buprenorphine‐naloxone doses of 24 mg appear to be associated with increased treatment retention compared with 16 mg and, for 6+ month episodes, 32 and 40 mg appear to be associated with increased retention compared with 24 mg. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: The association between buprenorphine doses above 16 milligrams and treatment retention in a multi‐payer national sample in the United States, 2014 to 2021.
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Jun2025, Vol. 120 Issue 6, p1198-1206. 9p.
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  Data: <searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Combination+drug+therapy%22">Combination drug therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Scientific+observation%22">Scientific observation</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Dose-effect+relationship+in+pharmacology%22">Dose-effect relationship in pharmacology</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Naloxone%22">Naloxone</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Buprenorphine%22">Buprenorphine</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink>
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  Data: Background and Aims: Buprenorphine‐naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40 mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine‐naloxone doses between 4 and 40 mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40 mg doses. Design: Observational cohort study in a national, multi‐payer sample of prescription claims (IQVIA) of episodes involving buprenorphine‐naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180 days. New episodes started with a 14+ day gap between prescriptions. Setting: United States of America. Participants: The sample involved 620 229 episodes across 498 879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine‐naloxone for OUD. Measurements The exposure was the maximum daily dose of buprenorphine‐naloxone reached in the first 30 days of an episode, ranging from 4 to 40 mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18 months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation. Findings Daily doses of 24, 32 and 40 mg increased retention compared with 16 mg at 1–18 months [adjusted odds ratio (aOR) range = 1.17; 95% confidence interval (CI) = 1.14, 1.20 at 18 months to 1.52 (CI = 1.49, 1.54) at 1 month, both for 24 mg]. In pairwise comparisons, 32 mg was favorable to 24 mg at 6, 12 and 18 months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12 months; aOR = 1.12 (95% CI = 1.06, 1.19) at 18 months], and 40 mg was favorable to 24 mg at 12 and 18 months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months]. Conclusions: Daily buprenorphine‐naloxone doses of 24 mg appear to be associated with increased treatment retention compared with 16 mg and, for 6+ month episodes, 32 and 40 mg appear to be associated with increased retention compared with 24 mg. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/add.70002
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        Text: English
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      – SubjectFull: Research funding
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              Text: Jun2025
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