What you need to know
Buprenorphine maintenance treatment is currently the recommended approach to reducing the risk of return to opioid use in people with opioid use disorder, but many stop their treatment for a variety of reasons, including stigma, costs and frequent healthcare appointments. Researchers conducted a study to identify the prescribing characteristics associated with opioid overdose and a return to opioid use in clients who taper their buprenorphine treatment. They found that there are major risks associated with tapering and that maintenance treatment is the best approach to reducing these risks. 'For those who do want to taper, tapering after at least one year of therapy, slower tapers and more time between dose decreases were all associated with reduced risk of overdose, regardless of taper duration.
What is this research about?
Buprenorphine is the first line of treatment for opioid use disorder. Although maintenance treatment with buprenorphine reduces the risk of return to opioid use, many stop their treatment for various reasons. People who are on maintenance treatment often experience stigma and may stop their treatment for this reason.
Those who stop their buprenorphine treatment have higher rates of return to non-prescribed opioids and overdose death. Researchers conducted a study to identify the prescribing characteristics associated with opioid overdose and a return to opioid use after tapering buprenorphine maintenance treatment.
What did the researchers do?
Using administrative health data from the province of Ontario, the researchers identified adults with at least one buprenorphine treatment episode who stopped treatment after at least 60 days of continuous use. To identify those who had a clinically meaningful break in therapy, they looked for gaps in buprenorphine prescriptions of at least 14 consecutive days.
The researchers looked at the time of an opioid overdose in the 18 months after a person discontinued buprenorphine. They also looked at the time it took to start tapering buprenorphine, the average rate of tapering, the percentage of days when the dose was decreased and the duration of the tapering period.
What did the researchers find?
The analysis included 5,774 first episodes of tapering and 677 subsequent episodes. Two-thirds of the sample returned to opioid use within 18 months of stopping buprenorphine.
The results show that, regardless of the length of the tapering period, there was a lower risk of opioid overdose in those who started tapering buprenorphine after at least one year of maintenance therapy, had a slower tapering rate and had more time between dose decreases.
The study authors note that these findings highlight the possible risks associated with buprenorphine tapering, including the risk of opioid overdose. Based on these findings, the researchers recommend continuing buprenorphine maintenance for as long as the client benefits from it and wants it.
Limitations of the research
The authors also point out several study limitations. For example, they were not able to determine if any participant had used non-prescribed opioids during the study period, so the researchers may have misclassified some participants as being abstinent. Also, the researchers could not be certain that a person took their buprenorphine as prescribed. In addition, to calculate the daily dose of buprenorphine, the researchers used prescription records, which may not accurately represent the actual dose taken.
How can you use this research?
Treatment providers, regulatory agencies, insurers, and support groups may find this research useful in their efforts to enhance the use of buprenorphine treatment. The study also provides useful information on when and how to taper off buprenorphine maintenance therapy.
About the researchers
Nikki Bozinoff1,2, Siyu Men3, Paul Kurdyak3,4,5, Peter Selby1,2,5,6, Tara Gomes3,7,8
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario