Edited by Manasi Talwadekar
TOPLINE:
Among youth who initiated buprenorphine treatment for opioid use disorder, four patterns of buprenorphine use were identified, with the most common being discontinuation within 3 months. Low adherence to medication or discontinuation was associated with increased risks for opioid overdose, emergency department use, and hospitalization.
METHODOLOGY:
- Researchers conducted a retrospective cohort study to assess the length of medication use for opioid use disorder and the level of adherence required to avoid adverse health outcomes.
- They analyzed data from the Massachusetts Public Health Data Warehouse (2014-2022), focusing on 11,649 youth aged 13-26 years (60.3% male; 85.9% non-Hispanic White) who initiated buprenorphine treatment.
- Group-based trajectory modeling was used to categorize patterns of adherence over 12 months among participants, including those who switched to methadone (5%) or naltrexone (6.6%).
- Adherence was assessed by the number of days the medication was dispensed, including 28 days post-injection for long-acting buprenorphine; the course of medication use was noted over 12 months after initiating buprenorphine.
- The primary outcome was the time to first opioid overdose, including both fatal and nonfatal overdoses, in months 13-24; secondary outcomes were time to first emergency department use and hospitalization.
TAKEAWAY:
- Four distinct patterns of adherence were identified in participants: high adherence for 12 months of approximately 75% or more for the first 9 months (23.7%), low adherence for 12 months of nearly 30% during the first 3 months (27.5%), discontinuation in 3-9 months (16.4%), and discontinuation in less than 3 months (32.5%). Death was reported in 1.3% of participants during the initial 12 months.
- Youth with low adherence for 12 months had a higher risk for opioid overdose during months 13-24 after the initiation of buprenorphine than those with high adherence for 12 months (adjusted hazard ratio [aHR], 1.82; 95% CI, 1.52-2.17). The risk was also higher in youth who discontinued medication in 3-9 months (aHR, 1.76; 95% CI, 1.50-2.06) and those who discontinued in less than 3 months (aHR, 1.46; 95% CI, 1.24-1.73).
- Discontinuation in 3-9 months was associated with a significantly higher risk for fatal opioid overdose than high adherence for 12 months (aHR, 1.76; 95% CI, 1.01-3.05).
- Youth with low adherence for 12 months (aHR, 1.09; 95% CI, 1.01-1.17) and those who discontinued medication in less than 3 months (aHR, 1.08; 95% CI, 1.01-1.16) had higher risks for emergency department use than those with high adherence for 12 months. Compared with high adherence for 12 months, all other adherence trajectories were associated with increased risks for inpatient hospitalization.
IN PRACTICE:
“Taken together, these results suggest that clinicians should counsel youth and families that research suggests that, after initiating buprenorphine, outcomes are best when youth continue to take medication (and are adherent) for longer periods of time,” the authors of the study wrote. “Amid unprecedented youth mortality resulting from fentanyl, optimizing medication use may be a key strategy to averting overdose and related harms in youth. Specifically, youth, families, clinicians, health systems, insurers, and policymakers should be aware that longer durations of treatment (ie, > 1 year) and higher adherence to medication (ie, ideally > 75% or higher) are associated with lower risk for subsequent opioid overdose, ED [emergency department] use, and hospitalization,” they added.