November 5, 2024

Urgent health care utilization was lower among commercially insured adults with opioid use disorder (OUD) taking a long-acting opioid antagonist medication used to treat opioid use disorder (OUD) at doses higher than currently recommended by the U.S. Food and Drug Administration (FDA). A high dose was defined as above 16 milligrams (mg) and up to 24 mg. The FDA-recommended dose is between 8 mg and 16 mg. People with opioid use disorder (OUD) who use potent synthetic opioids often require higher doses of medication-assisted treatment to effectively manage their condition. 

About 12.5% of those taking long-acting opioid antagonist medications experienced an emergency department visit or inpatient service. Those who were taking the medications at doses higher than 16 mg had a longer duration at 57.6 days in the unadjusted data without an emergency department visit or inpatient service than those taking the medication at doses of 8 mg to 16 mg. For those taking 24 mg or more, the duration without an emergency department visit or inpatient service was even longer, at 69.5 days in the unadjusted data. 

At each dosing level, about one-fifth had an emergency department visit or an inpatient service. Among those taking a dosage of more than 24 mg, 17.4% had an emergency department visit or an inpatient service. Among those taking a dose of more than 16 mg to 24 mg, 21.3% had an emergency department visit or inpatient service. Among those taking a dose of more than 8 mg up to 16 mg, 19.8% had an emergency department visit or inpatient service, as did 18.6% of those taking from 1 mg up to 8 mg. 

These findings were reported in “Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization” by Sarah Axeen, Ph.D.; Rosalie Liccardo Pacula, Ph.D.; Jessica S. Merlin, M.D., Ph.D., MBA; and colleagues. The researchers analyzed data from Optum’s deidentified Clinformatics Data Mart Database from 2016 to 2021 for 35,451 commercially insured individuals aged 18 years or older diagnosed with opioid use disorder (OUD) who were taking a long-acting opioid antagonist medication for 14 or more days. They compared differences in emergency department use and inpatient services between those taking the medication at high doses or at the FDA-recommended dose. About 27.3% of the people included in the study were taking from 1 mg to 8 mg daily; 42.9% were taking more than 8 mg to 16 mg daily; 29.1% were taking more than 16 mg up to 24 mg daily, and 1.8% were taking more than 24 mg daily. The adjusted outcomes were reported as a time ratio, an estimate of the time in days to the behavioral health-related emergency department or inpatient visit. 

The full text of “Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization” was published September 25, 2024, by JAMA Network Open.