Upping Dose of Anti-Opioid Drug Might Work Better to Curb Addiction

Patients with opioid use disorder who receive higher doses of a drug to treat their addiction are more likely to have positive results, a new study finds.

Daily doses of the drug buprenorphine is a standard treatment for opioid use disorder, and the findings suggest that higher doses may be a better way to manage it. Researchers say this could be an important way to improve treatment for people who use fentanyl, a major cause of opioid overdose.

“As the overdose crisis evolves, particularly with the rise of fentanyl, it is crucial to investigate how to best adapt and deliver the lifesaving and evidence-based treatments for opioid use disorder that we have available,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA).

For the study, researchers reviewed insurance claims data from more than 35,000 patients who entered buprenorphine treatment between 2016 and 2021. During that time, 12.5% required emergency or inpatient care for mental health issues.

The U.S. Food and Drug Administration recommends a daily dose of 16 milligrams (mg) of buprenorphine.

In the first year after receiving treatment, patients who took 16 to 24 mg of buprenorphine took 20% longer to have a subsequent ER or inpatient hospital visit than those receiving 8 to 16 mg a day.

Meanwhile, those taking more than 24 mg of buprenorphine a day went 50% longer before having an emergency or inpatient stay compared to those receiving 8 to 16 mg a day, the study found.

Studies have shown that doses of more than 16 mg of buprenorphine are safe and well-tolerated.

“The findings add to the growing evidence that higher doses of buprenorphine may have meaningful health impacts for people with opioid use disorder,” Volkow said in a NIDA news release.

The availability of potent fentanyl, a synthetic opioid that is roughly 50 times stronger than heroin, has accelerated the search for solutions to a nationwide opioid epidemic.

In 2022 alone, of nearly 108,000 overdose deaths reported nationwide, almost 70% were primarily due to fentanyl.

That trend has also raised questions about whether existing dosing guidelines for buprenorphine should be modified. Researchers said higher doses of buprenorphine may be needed to counteract the more severe withdrawal symptoms, cravings and tolerance associated with fentanyl use.

They said removing barriers to accessing higher doses — including insurance policies and state laws — will be a key to ensuring that all patients receive effective care.

“Preventing or delaying the need for high-intensity, urgent health care among people with opioid use disorder has tremendous benefits on health and recovery,” said study co-author Dr. Bradley Stein, director of the opioid policy, tools and information center at the RAND Institute, a health policy think tank.

Researchers noted that data used in the study were culled from one commercial insurer and do not include uninsured people or those with government coverage. In addition, the sample was made up overwhelmingly of white, non-Hispanic patients.

The findings were published Sept. 25 in JAMA Network Open.

More information

If someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health or substance abuse conditions, visit FindSupport.gov. To find a treatment provider or facility, go to FindTreatment.gov or call 800-662-4357.

SOURCE: National Institute on Drug Abuse, news release, Sept. 25, 2024