Opioid addiction has been increasing over the last decade or so in the US, with many deaths occurring as a result of opioid overdose. As a result, many programs have been set up to deal with this addiction using medications like buprenorphine. This is one of the three approved drugs that are used for this condition, and the most useful one.
It is estimated that more than 4 million prescriptions for this drug were issued in the period 2012 to 2014, and in the next year, there were at least 200 people out of every 100,000 adults with private health insurance who had filled 1 or more prescriptions for buprenorphine.
Yet, says a new study, this still excludes the majority of opioid addicts. This motivated them to investigate how buprenorphine is used by people between 15 and 80 years old, in terms of demographic group, the length of treatment and the period of use.
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The study looked at people identified in the QVIA Real World Data:Longitudinal Prescription (IQVIA LRx) database over the period 2009 to 2018, who received buprenorphine in formulations used specifically for opioid addiction. They computed the rate of buprenorphine usage, and the rate of prescription filling at least once, per 1000 people.
A new buprenorphine use episode was defined as one which started on the date of filling a prescription if it was at least 180 days after the previous fill and ended after the person was off buprenorphine for over 30 days. They also found the percentage of new buprenorphine use episodes lasting 180 days or more, and of new episodes where the dose was 16 mg/day or more. These parameters are used for national performance standards.
The researchers found that the rate of buprenorphine use went up from about 2 per 1,000 to over 4.4 per 1,000 over the study period. While the percentage of use went up dramatically, almost four-fold, among people 35-44 years old, it went down slightly among those aged 15-24 years old.
The percentage of use for 180 days or longer was over 29% in both males and females. In most of the episodes of new use, there was at least a single episode of prescription for 16 mg/day or more. These percentages were, again, lower in the 15-24 years age group than in the other groups.
The annual rate of buprenorphine treatment remains well below the national rate of opioid use disorder with prescription opioids, combined with heroin abuse. This shows that many addicts are not receiving treatment. The gap may be increasing in the 15-24 year age group, given the decreasing use of the drug in this group and the fact that the percentage of doses at 16 mg/day or more, and of 189 days or more of buprenorphine use, are both lower in this group, indicating that many of them are not getting the medication they need to recover from their addiction. The authors feel that public health services should target this group for better buprenorphine treatment to reduce the gap and help them recover to productive lives.
Olfson M, Zhang V, Schoenbaum M, King M. Trends in Buprenorphine Treatment in the United States, 2009-2018. JAMA. 2020;323(3):276–277. doi:10.1001/jama.2019.18913, https://jamanetwork.com/journals/jama/article-abstract/2758992