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. 2022 Dec 1;79(12):1173-1179.
doi: 10.1001/jamapsychiatry.2022.3118.

Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder

Jason B Gibbons  1 , Jeffrey S McCullough  2 , Kara Zivin  2   3   4 , Zach Y Brown  5   6 , Edward C Norton  2   5   6
Affiliations

Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder

Jason B Gibbons et al. JAMA Psychiatry. .

Abstract

Importance: Nonadherence to buprenorphine may increase patient risk of opioid overdose and increase health care spending. Quantifying the impacts of nonadherence can help inform clinician practice and policy.

Objective: To estimate the association between buprenorphine treatment gaps, opioid overdose, and health care spending.

Design, setting, and participants: This longitudinal case-control study compared patient opioid overdose and health care spending in buprenorphine-treated months with treatment gap months. Individuals who were US Medicare fee-for-service beneficiaries diagnosed with opioid use disorder who received at least 1 two-week period of continuous buprenorphine treatment between 2010 and 2017 were included. Analysis took place between January 2010 and December 2017.

Interventions: A gap in buprenorphine treatment in a month lasting more than 15 consecutive days.

Main outcomes and measures: Opioid overdose and total, medical, and drug spending (combined patient out-of-pocket and Medicare spending).

Results: Of 34 505 Medicare beneficiaries (17 927 [520%] male; 16 578 [48.1%] female; mean [SD] age, 49.5 [12.7] years; 168 [0.5%] Asian; 2949 [8.5%] Black; 2089 [6.0%] Hispanic; 266 [0.8%] Native American; 28 525 [82.7%] White; 508 [1.5%] other race), 11 524 beneficiaries (33.4%) experienced 1 or more buprenorphine treatment gaps. Treatment gap beneficiaries, compared with nontreatment gap beneficiaries, were more likely to be younger, be male, have a disability, and be Medicaid dual-eligible while less likely to be White, close to a buprenorphine prescriber, and treated with buprenorphine monotherapy (ie, buprenorphine hydrochloride). Beneficiaries were 2.89 (95% CI, 2.20-3.79) times more likely to experience an opioid overdose during buprenorphine treatment gap months compared with treated months. During treatment gap months, spending was $196.41 (95% CI, $110.53-$282.30) more than in treated months. Patients who continued to take buprenorphine dosages of greater than 8 mg/d and 16 mg/d were 2.61 and 2.84 times more likely to overdose in a treatment gap month, respectively, while patients taking buprenorphine dosages of 8 mg/d or less were 3.62 times more likely to overdose in a treatment gap month (maintenance of >16 mg/d: hazard ratio (HR), 2.64 [95% CI, 1.80-3.87]; maintenance of >8 mg/d: HR, 2.84 [95% CI, 2.13-3.78]; maintenance of ≤8 mg/d: HR, 3.62 [95% CI, 1.54-8.50]). Buprenorphine monotherapy was associated with greater risk of overdose and higher spending during treatment gaps months than buprenorphine/naloxone.

Conclusions and relevance: Medicare patients treated with buprenorphine between 2010 and 2017 had a lower associated opioid overdose risk and spending during treatment months than treatment gap months.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gibbons is a postdoctoral fellow at Johns Hopkins University and does research on substance use disorder policy as a part of the Bloomberg Opioid Initiative, which receives funding from Bloomberg Philanthropies. Dr McCullough has previously provided consulting services to CVS for an opioid litigation case. No other disclosures were reported.

Figures

Figure.
Figure.. Association Between Buprenorphine Treatment Gaps and Opioid Overdose: Cumulative Risk of Opioid Overdose
The x-axis reflects months since treatment initiation (month = 0 reflects the month of treatment initiation). The treatment gap (orange) reflects beneficiaries who had 15 consecutive days in a month without treatment, while no treatment gap (blue) reflected beneficiaries who were continuously treated for 15 consecutive days or more. Source: Centers for Medicare & Medicaid Services.,
See this image and copyright information in PMC

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