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Background and Aims: Opioid use disorder (OUD) is treatable with buprenorphine/naloxone (buprenorphine), but many patients discontinue treatment prematurely. The aim of this study was to assess the influence of patient- and prescriber-level characteristics relative to several patient outcomes following the initiation of buprenorphine treatment for OUD., Design: This was a retrospective observational investigation. We used the Public Health Data Warehouse from the Massachusetts Department of Public Health to construct a sample of patients who initiated buprenorphine treatment between 2015 and 2019. We attributed each patient to a prescriber based on information from prescription claims. We used multilevel models to assess the influence of patient- and prescriber-level characteristics on each outcome., Setting: Massachusetts, USA., Participants: The study cohort comprised 37 955 unique patients and 2146 prescribers. Among patients, 64.6% were male, 52.6% were under the age of 35 and 82.2% were White, non-Hispanic. For insurance coverage, 72.1% had Medicaid., Measurements: The outcome measures were poor medication continuity, treatment discontinuation and opioid overdose, all assessed within a 12-month follow-up period that began with a focal prescription for buprenorphine. Each patient had a single follow-up period. Poor medication continuity was defined as medication gaps totaling more than 7 days during the initial 180 days of buprenorphine treatment and treatment discontinuation was defined as having a medication gap for 2 consecutive months within the 12-month follow-up period., Findings: The patient-level rates for poor medication continuity, treatment discontinuation and opioid overdose were 59.7% [95% confidence interval (CI) = 59.2-60.2], 57.4% (95% CI = 56.9-57.9) and 10.3% (95% CI = 10.0-10.6), respectively, with 1.1% (95% CI = 1.0-1.2) experiencing a fatal opioid overdose. At the patient level, after adjustment for covariates, adverse outcomes were associated with race/ethnicity as both Black, non-Hispanic and Hispanic patients had worse outcomes than did White, non-Hispanic patients (Black, non-Hispanic -- poor continuity: 1.50, 95% CI = 1.34-1.68; discontinuation: 1.44, 95% CI = 1.30-1.60; Hispanic -- poor continuity: 1.21, 95% CI = 1.12-1.31; discontinuation: 1.38, 95% CI = 1.28-1.48). Patients with insurance coverage through Medicaid also had worse outcomes than those with commercial insurance (poor continuity: 1.18, 95% CI = 1.11-1.26; discontinuation: 1.09, 95% CI = 1.03-1.16; overdose: 1.98, 95% CI = 1.75-2.23). Pre-treatment mental health conditions and other types of chronic illness were also associated with worse outcomes (History of mental health conditions -- poor continuity: 1.11, 95% CI = 1.06-1.17; discontinuation: 1.05, CI = 1.01-1.10; overdose: 1.47, 95% CI = 1.36-1.60; Chronic health conditions -- poor continuity: 1.15, 95% CI = 1.05-1.27; discontinuation: 1.15, 95% CI = 1.05-1.26; overdose: 1.83, 95% CI = 1.60-2.10; History of substance use disorder other than for opioids -- poor continuity: 1.54, 95% CI = 1.46-1.62; discontinuation: 1.54, 95% CI = 1.47-1.62; overdose: 1.93, 95% CI = 1.80-2.07). At the prescriber level, after adjustments for covariates, adverse outcomes were associated with clinical training, as primary care physicians had higher rates of adverse outcomes than psychiatrists (poor continuity: 1.12, 95% CI = 1.02-1.23; discontinuation: 1.04, 95% CI = 1.01-1.09). A larger prescriber panel size, based on number of patients being prescribed buprenorphine, was also associated with higher rates of adverse outcomes (poor continuity: 1.36, 95% CI = 1.27-1.46; discontinuation: 1.21, 95% CI = 1.14-1.28; overdose: 1.10, 95% CI = 1.01-1.19). Between 9% and 15% of the variation among patients for the outcomes was accounted for at the prescriber level., Conclusions: Patient- and prescriber-level characteristics appear to be associated with patient outcomes following buprenorphine treatment for opioid use disorder. In particular, patients' race/ethnicity and insurance coverage appear to be associated with substantial disparities in outcomes, and prescriber characteristics appear to be most closely associated with medication continuity during early treatment., (© 2024 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Research has shown buprenorphine/naloxone to be an effective medication for treating individuals with opioid use disorder. At the same time, treatment discontinuation rates are reportedly high though much of the extant evidence comes from studies of the Medicaid population., Objectives: To examine the pattern and determinants of buprenorphine/naloxone treatment discontinuation in a population of commercially insured individuals., Research Design: We performed a retrospective observational analysis of Massachusetts All Payer Claims Data (MA APCD) covering years 2013 through 2017. We defined treatment discontinuation as a gap of 60 consecutive days without a prescription for buprenorphine/naloxone within a time frame of 24 months from the initiation of treatment. A mixed-effect Cox proportional hazard model examined the associated risk of discontinuing treatment with baseline predictors., Subjects: A total of 5134 individuals who were commercially insured during the study period., Measures: Buprenorphine/naloxone treatment discontinuation., Results: Overall 75% of individuals had discontinued treatment within two years of initiating treatment, and median time to discontinuation was 300 days. Patients aged between 18 and 24 years (HR = 1.436, 95%, CI = 1.240-1.663) and receiving treatment from prescribers with high panel-size (HR = 1.278, 95% CI = 1.112-1.468) had higher risk of discontinuing treatment. On the contrary, patients receiving treatment from multiple prescribers had lower associated risk of treatment discontinuation., Conclusions: A substantial percentage of patients discontinue treatment well before they can typically meet criteria for sustained remission. Further investigations should assess the clinical outcomes following premature discontinuation and identify strategies for retaining patients in treatment., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The brand name Suboxone and its generic formulation buprenorphine/naloxone is a medication for treating opioid use disorder. While this medication has been shown to be effective, little research has examined the extent to which it is being prescribed and under what circumstances. Objective: This study examined patterns of prescription claims for buprenorphine/naloxone in terms of volume and associated clinical conditions. Methods: The study was conducted using a statewide database comprising pharmacy and medical claims that were covered by commercial health insurance plans in Massachusetts between 2011 and 2015. Trends in prescription volume for buprenorphine/naloxone were assessed based on the annual number of patients with a prescription for buprenorphine/naloxone. To examine clinical conditions associated with buprenorphine/naloxone prescriptions, patients' pharmacy claims were linked to their medical claims within the prior three months. For patients with common pain-related conditions, the odds they were prescribed buprenorphine/naloxone rather than oxycodone, a widely used opioid for pain management, were also examined. Results: The number of patients with a buprenorphine/naloxone prescription increased substantially during the study period, from approximately 25,000 in 2011 to over 39,000 in 2015. The most common clinical condition associated with buprenorphine/naloxone prescribing was opioid use disorder, but a substantial percentage of prescriptions were preceded by diagnoses that included pain or were for pain alone. Conclusion: A substantial increase in the number of patients with a prescription for buprenorphine/naloxone was observed. While buprenorphine/naloxone is most frequently prescribed for opioid use disorder, clinicians also appear to prescribe it for pain, particularly for patients who may be at elevated risk for opioid use disorder.