Buprenorphine: Being out of treatment increases risk of death nearly 30-fold

Choose you evidence carefully by rocket ship

The title of this post is taken directly from a press release for a recently published study. Here’s the summary:

Buprenorphine reduces mortality for those with opioid use disorder, but periods off treatment are associated with much higher mortality rates. A study of 713 new outpatient users of buprenorphine was conducted in France, where patients with opioid use disorder are usually treated by general practitioners in private practice with periods in and out of treatment. The mortality rate for study subjects was 0.63/100 person-year [95 percent CI 0.40- 0.85], compared to 0.24/100 person-year [0.24-0.25] for other individuals of the same age range during the same time period. The authors encourage physicians to avoid interruption of treatment and encourage patients to remain in treatment for a sufficient amount of time.

There’s no debate that buprenorphine provides protection against overdose when patients are taking it.

However, that’s a very important qualifier and it often gets lost when talking about the evidence for treatment options.

The problem is that studies have not been very successful at getting people to take it on an ongoing basis.

In a study published earlier this year, they looked at records of 38,000 american buprenorphine patients. What did they find?

For their study, Alexander and his colleagues examined pharmacy claims for more than 38,000 new buprenorphine users who filled prescriptions between 2006 and 2013 in 11 states. They looked at non-buprenorphine opioid prescriptions before, during, and after each patient’s first course of buprenorphine treatment, which typically lasted between one to six months. Even though there are no universally agreed-upon guidelines regarding the optimal length of treatment, most people discontinued buprenorphine within three months.

They found that 43 percent of patients who received buprenorphine filled an opioid prescription during treatment and 67 percent filled an opioid prescription during the 12 months following buprenorphine treatment. Most patients continued to receive similar amounts of opioids before and after buprenorphine treatment.

They described buprenorphine’s impact and retention like this:

Buprenorphine therapy was associated with modest declines in most measures of opioid use following the first treatment episode; however, only 33% of patients continued to fill prescriptions for buprenorphine after 3 months.

So . . . protection from overdose is one of the most important benefits of buprenorphine treatment, BUT by day ninety, 67% of buprenorphine patients are no longer taking the drug and therefore not protected from overdose.

PS – This is not meant to imply that buprenorphine is bad, or shouldn’t be an option. One of the limitations of abstinence-based treatments is that they also struggle with retention and the risk of overdose when relapse occurs.

PSS – (For a more comprehensive review of a frequently cited meta-analysis of medication-assisted treatment, check this out.)