Buprenorphine Treatment Retention Improved with Higher Doses and Initiation Prior to Referral to Outpatient Settings

Buprenorphine is a highly efficacious treatment for opioid use disorder (OUD). Unfortunately, buprenorphine treatment initiation and retention rates are low. This systematic review sought to identify characteristics associated with buprenorphine treatment retention among 9 randomized controlled trials meeting the study’s inclusion criteria.

• Buprenorphine dose of 8 mg daily resulted in higher 12-month retention (63%-78%), compared with 1–3 mg daily (17%-60%).
• Adjunctive intensive behavioral therapy did not improve buprenorphine treatment retention compared with standard behavioral therapy.
• Initiating buprenorphine prior to referral to outpatient settings resulted in higher treatment retention, compared with patients who did not initiate buprenorphine prior to referral:
  • For hospitalized patients with OUD, 6-month retention was 17% if buprenorphine was started prior to discharge, compared with 2% for those referred for outpatient treatment.
  • For incarcerated patients with OUD, individuals starting buprenorphine prior to release were retained for a mean of 66 days compared with 22 days for those referred for outpatient treatment.

Comments: Improving buprenorphine treatment retention is a critical strategy to achieve improved outcomes for individuals with OUD, but data from randomized controlled trials to identify strategies that improve retention are limited. In this study, higher buprenorphine doses and buprenorphine initiation prior to referral to outpatient treatment settings were associated with longer treatment retention, but additional strategies to improve buprenorphine treatment retention need to be identified.

Marc R. Larochelle, MD, MPH

Reference: Kennedy AJ, Wessel CB, Levine R, et al. Factors associated with long-term retention in buprenorphine-based addiction treatment programs: a systematic review. J Gen Intern Med. 2021;10.1007/s11606-020-06448-z.