Evidence on Buprenorphine Dose Limits: A Review

Journal of Addiction Medicine, Journal Year: 2023, Volume and Issue: 17(5), P. 509 - 516

Published: June 16, 2023

As overdose deaths from fentanyl continue to increase, optimizing use of medications for opioid disorder has become increasingly important. Buprenorphine is a highly effective medication reducing the risk death, but only if patient remains in treatment. Shared decision making between prescribers and patients important establish dose that meets each patient's treatment needs. However, frequently face limit 16 or 24 mg/d based on dosing guidelines Food Drug Administration's package label.This review discusses patient-centered goals clinical criteria determining adequacy, reviews history buprenorphine regulation United States, examines pharmacological research results with doses up 32 mg/d, evaluates whether diversion concerns justify maintaining low limit.Pharmacological consistently demonstrate buprenorphine's dose-dependent benefits at least including reductions withdrawal symptoms, craving, reward, illicit while improving retention care. Diverted most often used treat symptoms reduce when legal access it limited.In light established profound harms fentanyl, current recommendations target are outdated causing harm. An update label recommended elimination would improve effectiveness save lives.

Language: Английский

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Pandemic telehealth flexibilities for buprenorphine treatment: a synthesis of evidence and policy implications for expanding opioid use disorder care in the United States

Health Affairs Scholar, Journal Year: 2023, Volume and Issue: 1(1)

Published: June 20, 2023

Buprenorphine is a highly effective treatment for opioid use disorder (OUD) and critical tool addressing the worsening US overdose crisis. However, multiple barriers to treatment-including stringent federal regulations-have historically made this medication hard reach many who need it. In 2020, under COVID-19 public health emergency, regulators substantially changed access buprenorphine by allowing prescribers initiate patients on via telehealth without first evaluating them in person. As emergency has been set expire May of 2023, Congress agencies can leverage extensive evidence from studies conducted during wake pandemic make evidence-based decisions regulation going forward. To aid policy makers, narrative review synthesizes interprets peer-reviewed research effect flexibilities uptake implementation telehealth, its impact OUD patient prescriber experiences, treatment, outcomes. Overall, our finds that took advantage including audio-only option, with wide range benefits few downsides. result, regulators-including Congress-should continue nonrestricted initiation.

Language: Английский

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Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study

Annals of Medicine, Journal Year: 2023, Volume and Issue: 55(1), P. 733 - 743

Published: March 1, 2023

Background: At the start of pandemic, relaxation buprenorphine prescribing regulations created an opportunity to create new models medications for opioid use disorder (MOUD) delivery and care. To expand improve access MOUD, we adapted implemented Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based peer-driven intervention promote HIV viral suppression among people who inject drugs (PWID) accessing syringe services program (SSP). This study examined initiation retention PWID with received THR at IDEA Miami SSP.Methods: A retrospective chart review participants MOUD was performed examine impact telehealth on retention. Our primary outcome three-month retention, defined as three consecutive months dispensed from pharmacy.Results: total 109 intervention. Three-month rate 58.7%. Seeing provider via baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) had escalating dose after 8.09, [1.83, 35.87]) higher adjusted odds months. Participants self-reported tested positive stimulant (methamphetamine, amphetamine, cocaine) lower 0.29, [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically needs in provision critical lifesaving truly destigmatising approach. pilot suggests that SSP may be acceptable feasible venue increase uptake by care.KEY MESSAGESThe initiating retaining within settingUsing associated increased retentionBaseline negatively

Language: Английский

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“You might be nice, but where you take me, they're not gonna be”: Preferences for field‐based post‐overdose interventions

Drug and Alcohol Review, Journal Year: 2024, Volume and Issue: 43(7), P. 1865 - 1879

Published: Aug. 28, 2024

Emergency medical services (EMS) systems are piloting interventions to respond overdoses with additional such as leave-behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who drugs (PWUD) on these being delivered by EMS during an overdose response.

Language: Английский

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Perceptions, policies, and practices related to dispensing buprenorphine for opioid use disorder: A national survey of community-based pharmacists

Journal of the American Pharmacists Association, Journal Year: 2022, Volume and Issue: 63(1), P. 252 - 260.e6

Published: Aug. 24, 2022

Language: Английский

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Early findings on home delivery of buprenorphine and retention in treatment for opioid use disorder

Addiction Science & Clinical Practice, Journal Year: 2025, Volume and Issue: 20(1)

Published: Feb. 12, 2025

Abstract Individuals with opioid use disorder face barriers accessing first-line pharmacotherapy. Home delivery interventions have been shown to improve medication adherence for other chronic diseases, but the relationship between buprenorphine home and treatment outcomes has not assessed. We evaluated association retention in a feasibility study of adults who initiated telemedicine received one or more prescriptions. described characteristics patients estimated odds attending visit three six months after enrollment as function using logistic regression. The sample consisted 337 following characteristics: mean age 40.8 years (SD 10.1), 51.0% male, 70.9% commercially insured. In first 30 days 6.8% ( n = 23) used delivery. At months, percentages individuals retained among those without were 82.6% 58.9%, respectively (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 1.10–9.96). 78.6% 45.5%, (OR: 4.39, CI: 1.19–16.25, 203). Although uptake through pharmacy partner was low within this receiving disorder, its associated increased care at months. Given small size, uptake, limited statistical power, additional research is warranted.

Language: Английский

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Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study

Addiction Science & Clinical Practice, Journal Year: 2025, Volume and Issue: 20(1)

Published: March 4, 2025

Abstract Background Deaths from opioid overdose have increased dramatically in the past decade. For individuals with use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity mortality. Historically, provision of treatment office-based settings has relied on frequent in-person contact, likely influencing patients’ access to retention care. In response COVID-19 pandemic, providers rapidly adapted their care processes, increasingly relying telemedicine visits. To date, relatively few prior studies combined patient clinician perspectives examine implementation related adaptations, particularly safety-net settings. Methods Qualitative methods were used explore experiences an clinic affiliated urban hospital. From this clinic, we conducted semi-structured interviews 25 patients 16 clinicians (including prescribers non-prescribers). We coded all interview data a thematic analysis approach understand how impacted quality engagement care, well preferences for using moving forward. Results Five themes regarding other COVID-19-related adaptations arose perspectives: (1) integration precipitated openness more flexibility practices, (2) concerns telemedicine-related centered around safety accountability, (3) encounters required rapport trust between facilitate open communication, (4) populations experienced unique challenges when telemedicine, terms technology need privacy, (5) there is important role forward, primarily through its hybrid models which integrate both virtual Conclusions Telemedicine within potential improve care; however, our findings emphasize tailored approaches implementing treatment, Overall, study supports maintenance changes policy practice that beyond public health emergency.

Language: Английский

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A multi-method spatial examination of factors associated with changes in geographic accessibility to buprenorphine providers in HEALing communities study states Kentucky, Massachusetts, and Ohio

Preventive Medicine Reports, Journal Year: 2025, Volume and Issue: unknown, P. 103045 - 103045

Published: March 1, 2025

Language: Английский

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Addressing buprenorphine bottlenecks in the context of MAT Act implementation: A shared responsibility

Journal of the American Pharmacists Association, Journal Year: 2023, Volume and Issue: 63(4), P. 1044 - 1048

Published: May 4, 2023

Language: Английский

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Patient-reported problems filling buprenorphine prescriptions and motivations for illicit use

Drug and Alcohol Dependence Reports, Journal Year: 2022, Volume and Issue: 5, P. 100091 - 100091

Published: Sept. 8, 2022

While barriers to accessing buprenorphine (BUP) therapy have been well described, little is known about pharmacy-related barriers. The objective of this study was estimate the prevalence patient-reported problems filling BUP prescriptions and determine whether these were associated with illicit use BUP. secondary objectives included identifying motivations for naloxone acquisition among patients prescribed BUP.Between July 2019 March 2020, 139 participants receiving treatment an opioid disorder (OUD) at two sites within a rurally-located health system, completed anonymous 33-item survey. A multivariable model used assess association between substance use.More than third reported having their prescription (34.1%, n = 47) most commonly being insufficient pharmacy stock (37.8%, 17), pharmacist refusal dispense insurance (34.0%, 16). Of those who (41.5%, 56), common avoid/ease withdrawal symptoms (n 39), prevent/reduce cravings maintain abstinence 30), treat pain 19). In model, significantly more likely illicitly obtained (OR=8.93, 95% CI: 3.12, 25.52, p < 0.0001).Efforts improve access primarily focused on increasing number clinicians waivered prescribe; however, challenges persist dispensing coordinated efforts may be needed systematically reduce

Language: Английский

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