Buprenorphine Adherence Trajectories and Their Impact on Opioid Overdose and Healthcare Costs

Introduction Buprenorphine is effective for opioid use disorder (OUD), yet adherence remains suboptimal. This study aimed to identify adherence trajectories, explore their predictors, and assess their association with opioid overdose risk and healthcare costs. Methods A retrospective cohort study was conducted using the Merative MarketScan Commercial Database, which includes a nationally representative sample of individuals with private, employer‐sponsored health insurance in the United States. We included adults (≥ 16 years) with OUD who initiated and completed at least 30 consecutive days of buprenorphine treatment between July 2017 and June 2019, with a 180‐day follow‐up. Group‐based trajectory modelling identified distinct adherence patterns. Multinomial logistic regression examined predictors of adherence trajectories. A discrete‐time survival model estimated the association between adherence and opioid overdose risk, while generalised linear models assessed healthcare costs. Sensitivity analyses, including E‐value calculations, evaluated residual confounding. Results Among the 5107 individuals (median [Q1‐Q3] age in years: 37 [26–47]; 3185 [62.4%] male), three distinct buprenorphine adherence trajectories were identified in the follow‐up period: consistent adherence (CA, 49.5%), slow‐declining adherence (SDA, 28.0%) and rapidly‐declining adherence (RDA, 22.5%) trajectory groups. The mean (95% CI) time to buprenorphine discontinuation among all beneficiaries was 153 (151–155) days. Compared to the CA group, SDA and RDA groups had 2.74 (95% CI 2.71–2.77) and 3.81 (95% CI: 3.76–3.86) times higher opioid overdose risk and $13,670 (95% CI $7644–$19,695) and $19,431 (95% CI $13,632–$25,229) higher healthcare spending, respectively. Discussion and Conclusions Consistent adherence to buprenorphine was associated with a lower risk of opioid overdose and reduced healthcare expenditures.