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Comparative Study
. 2025 Apr:138:104748.
doi: 10.1016/j.drugpo.2025.104748. Epub 2025 Feb 27.

Retention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from a nationally representative sample of commercially-insured people with opioid use disorder in the United States

Roman Ivasiy  1 , Lynn M Madden  2 , Kimberly A Johnson  3 , Eteri Machavariani  4 , Bachar Ahmad  5 , David Oliveros  4 , Jiale Tan  6 , Natalie Kil  4 , Frederick L Altice  7
Affiliations
Comparative Study

Retention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from a nationally representative sample of commercially-insured people with opioid use disorder in the United States

Roman Ivasiy et al. Int J Drug Policy. 2025 Apr.

Abstract

Background and aims: Maintenance on medications for opioid use disorder, particularly buprenorphine, is critical for reducing overdose risk and improving health outcomes in the United States. This study evaluates retention and dropout probabilities between sublingual buprenorphine (SL-BUP) and extended-release buprenorphine (XR-BUP) among commercially-insured individuals with opioid use disorder (OUD).

Design and setting: A retrospective cohort study using Meretive™ Markeskan® claims data from 2019 to 2020. A multi-state Markov model assessed transitions between treatment states over 12 months.

Participants: The study included 58,933 individuals aged 18-64 years with OUD, initiating SL-BUP (n = 57,520) or XR-BUP (n = 1,413). XR-BUP patients were divided into XR-BUP only (n = 684; 49 %) and XR-BUP with supplemental SL-BUP (XR-BUP+sSL; n = 729; 51 %).

Measurements: Primary outcomes included probabilities of remaining in treatment or transitioning between states at 1, 3, 6, and 12 months. The impact of dosage and days of supply on retention was also examined.

Results: The probability of permanent treatment dropout at 6 months was similar for SL-BUP (38.59 %, 95 % CI: 37.9 %-39.4 %) and XR-BUP (41.3 % 95 %CI: 36.8 %-46.1 %), yet the probability of remaining in treatment was significantly higher for SL-BUP than XR-BUP (49.5 %; 95 %CI: 48.8 %-50.1 % vs. 13.5 % 95 % CI: 10.5 %-16.5 %). The high proportion of individuals initially prescribed XR-BUP later transitioned to SL-BUP. Higher doses and longer days supplied of SL-BUP reduced dropout rates. Among patients receiving ≥16 mg/day and ≥28 days, dropout probabilities were 5.7 % (95 % CI: 5.4 %-6.0 %) at 1 month, 15.4 % (95 % CI: 14.8 %-16.2 %) at 3 months, 28.0 % (95 % CI: 26.9 %-29.2 %) at 6 months, and 47.8 % (95 %CI: 45.2 %-49.5 %) at 12 months. In contrast, patients prescribed <16 mg/day and <28 days had a 46.3 % (95 %CI: 45.0 %-47.6 %) dropout rate by 6 months.

Conclusion: SL-BUP demonstrates higher retention rates and lower dropout compared to XR-BUP in real-world settings. Optimizing SL-BUP dosing and providing extended supplies can improve retention and reduce treatment discontinuation.

Keywords: Buprenorphine; Communicable comorbidities; Extended-release buprenorphine; HCV; HIV; Medications for opioid use disorder (MOUD); Opioid use disorder; Treatment initiation; Treatment retention.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1.
Fig. 1.
Estimated probabilities of transition (PT) and probabilities of remaining on treatment (PR) for a 1, 3, 6 and 12-month period and their 95 % confidence intervals. PT and PR presented in this model were adjusted to baseline BUP dose and Days of Supply, Age and Sex.
Fig. 2.
Fig. 2.
Probability remaining on the buprenorphine treatment (sublingual vs long-acting injectable) at various time points over 12 months.
Fig. 3.
Fig. 3.
Probabilities of permanent dropout from different types of buprenorphine-based medication-assisted treatment at 1, 3, 6 and 12 months.
See this image and copyright information in PMC

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