Higher dose may increase adherence to buprenorphine medication-assisted treatment
SAN ANTONIO — Buprenorphine medication-assisted treatment adherence was associated with higher dose, older age and previous history of psychosocial therapy, according to data presented at U.S. Psychiatric and Mental Health Congress.
To determine factors associated with adherence to buprenorphine medication-assisted treatment in the first year following treatment initiation, researchers conducted a retrospective cohort study of administrative medical and pharmacy claims for commercial (n = 16,085) and Medicaid (n = 5,688) claims for individuals with a diagnosis of opioid use disorder initiating buprenorphine medication-assisted treatment. Buprenorphine medication-assisted treatment was measured over 12 months after initiation, using proportion of days covered. Participants with a proportion of days covered of 0.8 or greater were considered adherent. Participants had a mean age of approximately 32 years.
Overall, 37.1% of commercial participants and 41.3% of Medicaid participants were adherent to buprenorphine medication-assisted treatment.
Increased odds for adherence were associated with receiving a higher average daily dose (24 mg or greater) of buprenorphine, older age, living in a rural area, living in the Northeast, use of other medication-assisted treatment prior to buprenorphine initiation, and receiving psychosocial therapy prior to buprenorphine initiation among commercial participants.
Increased odds for adherence were associated with similar factors among Medicaid participants, in addition to higher patient out-of-pocket costs on index buprenorphine fill.
Factors associated with decreased odds for adherence among commercial participants included receiving a lower average daily dose (12 mg or less) of buprenorphine per day, residing in the West region of the U.S., higher Charlson Comorbidity Index score, being a dependent or spouse of the primary insurance subscriber, and having a claim with a diagnosis code for alcohol abuse disorder, non-opioid substance use disorder, depression or bipolar disorder.
Decreased odds for adherence were associated with similar factors among Medicaid participants, in addition to having access restrictions to buprenorphine treatment such as quantity limits, lifetime treatment limits or frequent prior authorization and having an outpatient pharmacy claim for an opioid analgesic prior to buprenorphine initiation.
“These findings show that there are a lot of opportunities for those treating opioid addiction (ie, patients, clinicians, and payers) to improve adherence. I think the one big take away is that dose seemed to be important. In addition, adequate management of other mental health conditions should also improve adherence,” study researcher Tina M. Willson, PhD, of Truven Health Analytics Inc., told Healio.com/Psychiatry. – by Amanda Oldt
Wollschlaeger BA, et al. Factors associated with buprenorphine medication-assisted treatment adherence in patients diagnosed with opioid use disorder. Presented at: U.S. Psychiatric and Mental Health Congress; Oct. 21-24, 2016; San Antonio.
Disclosure: Willson is an employee of Truven Health Analytics, an IBM company, which funded the study.