Most Read Articles
13 Sep 2020
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Buprenorphine discontinuation ups risk of overdose, acute care service use

26 Dec 2019

Regardless of treatment duration, discontinuation of long-term buprenorphine heightens the risk of acute care service use and overdose in adults with opioid use disorder, reports a study.

“Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months,” the investigators said.

This retrospective longitudinal cohort analysis used the MarketScan multistate Medicaid claims database (2013–2017), covering 12 million beneficiaries annually. Adults (aged 18–64 years) who received buprenorphine continuously for ≥180 days by cohorts retained for 6–9 months, 9–12 months, 12–15 months and 15–18 months were included.

Assessment of outcome in the postdiscontinuation period required patients to be continuously enrolled in Medicaid for 6 months following buprenorphine cessation. Primary adverse outcomes were as follows: all-cause emergency department (ED) visits, all-cause inpatient hospitalizations, opioid prescriptions and drug overdose (opioid or nonopioid).

Adverse events were common across all cohorts. Nearly half of the patients (42.1–49.9 percent) visited the ED at least once.

Patients retained on buprenorphine for 15–18 months (n=931) vs 6–9 months (n=4,126) had a significantly lower likelihood of visiting the ED (odds ratio [OR], 0.75, 95 percent confidence interval [CI], 0.65–0.86), filling opioid prescriptions (OR, 0.67, 95 percent CI, 0.56–0.80) and inpatient hospitalizations (OR, 0.79, 95 percent CI, 0.64–0.99) in the 6 months following discontinuation.

Across all cohorts, about 5 percent of patients had one or more medically treated overdoses.

“Superior outcomes became significant with treatment duration beyond 15 months, although rates of the primary adverse outcomes remained high,” the investigators said.

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.