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Opioid use disorder is a chronic disease characterized by a maladaptive pattern of opioid use despite negative consequences. In the US, nearly 75 000 overdose deaths occurred in 2023, a 10-fold increase from 1999.1 However, only 1 in 4 US adults eligible for MOUD received it in 2022.2 The 2024 CRISM guideline outlines evidence-based OUD management that can be implemented by clinicians with or without specialized MOUD training for patients aged 18 years or older.3 It does not address withdrawal induction protocols, scheduling of opioid agonist therapies, or urine drug testing.
Question: Are higher doses of buprenorphine treatment for opioid use disorder associated with improved retention in treatment when use of fentanyl (vs heroin) is more prevalent?
Findings: In this cohort study of 6499 patients initiating buprenorphine treatment between 2016 and 2020, those prescribed the recommended daily dose (16 mg) were at significantly greater risk of treatment discontinuation within 180 days than those prescribed a higher dose (24 mg).
Meaning: The results of this study suggest that the value of higher buprenorphine doses than currently recommended needs to be considered for improving retention in treatment.
