Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 9;20(1):33.
doi: 10.1186/s13722-025-00547-0.

Cross-sectional examination of characteristics of higher-dose buprenorphine prescriptions during the era of illicit fentanyl

Bradley D Stein  1 , Flora Sheng  2 , Brendan K Saloner  3 , Adam J Gordon  4   5 , Jessica S Merlin  6
Affiliations

Cross-sectional examination of characteristics of higher-dose buprenorphine prescriptions during the era of illicit fentanyl

Bradley D Stein et al. Addict Sci Clin Pract. .

Abstract

Background: In response to greater illicit fentanyl use, buprenorphine daily doses exceeding the FDA's recommended target daily dose (16 mg) and maximum suggested daily dose (24 mg) may provide better outcomes, but little is known about higher dosage prescribing patterns. To better understand buprenorphine prescribing patterns, this manuscript examines the frequency and characteristics of dispensed buprenorphine of ≤ 16mg, > 16-24 mg, and > 24 mg daily dose.

Methods: We used IQVIA data to conduct a cross-sectional study of opioid use disorder-indicated buprenorphine prescriptions dispensed at retail pharmacies January 2019 - December 2020; categorized prescriptions as ≤ 16mg, > 16 to 24 mg, and > 24 mg daily dose; and examined overall rates and rates by patient, insurer and county characteristics, and prescriber specialty. We categorized buprenorphine prescriptions by patient sex, age cohort, primary payment source, and prescriber specialty and state and conducted univariate and bivariate analyses of buprenorphine daily dose categories overall and among clinicians frequently prescribing buprenorphine at the highest doses, > 24 mg.

Results: Approximately 19.5% (n = 5,568,964) of the 28 million buprenorphine prescriptions from 68,898 clinicians were > 16-24 mg; 2% (n = 641,390) were > 24 mg. Approximately 26% (n = 17,939) of clinicians wrote at least one prescription > 24 mg; 2,780 clinicians (4% of buprenorphine prescribers) were responsible for 82.2% (n = 527,597) of dispensed prescriptions > 24 mg. 28% of prescriptions > 24 mg written by these prescribers were cash-pay, 12.5% covered by Medicaid, and 6.7% covered by Medicare. There was no correlation between state fentanyl overdose rate and buprenorphine prescriptions > 24 mg per 1,000,000 residents.

Conclusions: In 2019-2020, fewer than 3% of dispensed buprenorphine prescriptions exceeded the FDA suggested maximum of 24 mg daily dose; 80% of the prescriptions for a > 24 mg daily dose were written by 4% of buprenorphine prescribers. As clinicians and policymakers pay greater attention to ensuring individuals are receiving buprenorphine dosages adequate to effectively treat their opioid use disorder, the recently revised FDA recommendations may encourage such behavior. Additionally, disproportionate reliance on cash payment for higher daily doses suggests public and private insurers could facilitate access to such treatment when appropriate.

Keywords: Buprenorphine; Insurance; Opioid use disorder.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: The corresponding author’s Institutional Review Board approved the study with a waiver of consent. Consent for publication: N/A. Conflict of interest: The authors have no conflicts of interest to disclose. The manuscript represents valid work and that neither this manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere.

Figures

Fig. 1
Fig. 1
Cumulative percentage of dispensed buprenorephine prescriptions > 24 mg written by prescribers of > 24 mg buprenorphine
Fig. 2
Fig. 2
State high dose buprenorphine dispensing and 2018 state fentanyl fatal overdose rate Pearson Correlation ρ= -0.31 (p = 0.026)
Fig. 3
Fig. 3
State high dose buprenorphine dispensing and fentanyl fatal overdose rate
See this image and copyright information in PMC

References

    1. National Center for Health Statistics. Multiple Cause of Death 1999–2021. CDC WONDER Online Database. 2023. https://wonder.cdc.gov/mcd.html. Accessed 22 January 2024.
    1. Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp BA, Ramsey KS. ASAM Clinical considerations: Buprenorphine treatment of opioid use disorder for individuals using high-potency synthetic opioids. J Addict Med. 2023;17(6):632–9. - PubMed
    1. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137–45. - PMC - PubMed
    1. Samples H, Williams AR, Crystal S, Olfson M. Impact of long-term buprenorphine treatment on adverse health care outcomes in Medicaid. Health Aff (Millwood). 2020;39(5):747–55. - PMC - PubMed
    1. Xu KY, Gertner AK, Greenfield SF, Williams AR, Grucza RA. Treatment setting and buprenorphine discontinuation: an analysis of multi-state insurance claims. Addict Sci Clin Pract. 2024;19(1):17. - PMC - PubMed

MeSH terms