Non-buprenorphine opioid utilization among patients using buprenorphine

Abstract

Background and aims: Buprenorphine is commonly used to treat opioid use disorder; however, non-buprenorphine prescription opioid use among these patients is not well defined. We sought to estimate the prevalence of non-buprenorphine opioid use among incident buprenorphine users and quantify levels of opioid use prior to, during and after the first treatment episode.

Design: We used QuintilesIMS anonymized, individual-level, all-payer pharmacy claims to identify incident users of buprenorphine between January 2010 and July 2012 from a large cohort of approximately 50 million patients filling two or more prescriptions for any opioid during any calendar year between 2006 and 2013 in 11 states of interest.

Setting: Eleven states within the United States.

Participants: Of the individuals who met our inclusion criteria (n = 38 096), 55% were female and half were aged between 29 and 54 years. Median length of the first treatment episode was 55 days [interquartile range (IQR) = 28-168 days].

Measurements: We calculated four measures of non-buprenorphine opioid use: (1) number of prescriptions, (2) quantity dispensed, (3) days of supply and (4) total morphine milligram equivalents (MME) before, during and after the first treatment episode. Our primary outcome was the MME per opioid day supplied during each time period.

Findings: Approximately two-fifths (43%) of buprenorphine recipients filled an opioid prescription during the treatment episode and two-thirds (67%) filled an opioid prescription following treatment. The mean total of MME per opioid day supplied 12 months prior to treatment declined from 57 mg/per day [95% confidence interval (CI) = 57, 58] to 54 mg/per day (95% CI = 54, 55) during the treatment episode, then remained constant at 55 mg/per day (95% CI = 54, 56) following the treatment episode.

Conclusions: The use of buprenorphine for the treatment of opioid use disorder has increased markedly in the United States. However, a substantial proportion of patients fill prescriptions for non-buprenorphine opioids during and following such treatment.

Keywords: Buprenorphine; care coordination; chronic pain; opioid analgesic; opioid use disorder; quality of care.