Many patients struggle to stop buprenorphine use
Many patients who want to stop using buprenorphine for opioid use disorder were not able to, according to findings recently published in Drug and Alcohol Dependence.
“Every day in my clinic one of my patients tells me he/she is thinking about tapering off buprenorphine and often when I try to start patients on medication, they are reluctant to start as they are concerned about eventually coming off,” Zoe M. Weinstein MD, MS, the director of the Addiction Consult Service, Boston Medical Center, told Healio Family Medicine. “I know tapering off is an important goal for many of my patients, but I felt I did not have enough information to counsel them correctly.”
Researchers conducted a retrospective cohort study of 1,308 adults receiving buprenorphine. During a median follow-up of 316 days, 48 patients tapered off the medication, for an estimated proportion of 15% (95% CI, 10–21) of all patients. Only 22 of these tapers were medically supervised, and after a median follow-up of 490 days, 13 of the 48 patients resumed buprenorphine treatment.
Characteristics of the 48 patients who were able to taper off buprenorphine included: mean age of initial opioid use was 22 years; mean age of enrolling in an office-based addiction treatment clinic was 38 years; 74.5% were white; 37.5% were women; and 30.8% had not finished high school. In addition, 41.7% of the 48 patients who were able to stop using buprenorphine had a lowest mean daily dose of more than 8 mg before taper completion, 31.3% of patients had a minimum daily dose 4 mg or less prior to completing the taper, and 27.1% had a minimum dose between 8 mg and 5 mg.
“Coming off a chronic medication is hard for any disease. Patients who want to make diet and lifestyle changes and get off diabetes and BP medications struggle to do so, so I was not surprised how few patients were able to taper off and remain off medications,” Weinstein said.
“These findings highlight the chronic relapsing nature of [the opioid epidemic], and that we need to help people get into and stay in care. Some insurances have put caps on how long people can be on buprenorphine. These findings show that many people need indefinite maintenance, and we need to make sure people can continue on with lifesaving care, which is why health care parity is essential in addressing the opioid epidemic,” she added. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.