Patient Profiles of Buprenorphine Initiators in General Healthcare Settings: A Latent Class Approach

Background Buprenorphine is the most commonly used medication for treating opioid use disorder (OUD). It may also be beneficial for individuals with chronic pain who are physically dependent on opioids but do not meet the criteria for OUD. Therefore, the buprenorphine patient population may be heterogeneous in terms of OUD and comorbidities. Objectives To characterize the heterogeneity of patient profiles among those initiating buprenorphine treatment in a large multi-state healthcare system, focusing on comorbid pain, psychiatric, and substance use disorder diagnoses, and other patient characteristics associated with profiles. Design Retrospective cohort study using electronic health record data. Partcipipants Patients with at least 12 months of data before a new buprenorphine prescription (OUD formulation) and at least 6 months of follow-up. Main Measures Presence vs absence of opioid use disorder diagnoses and latent class profiles of comorbid diagnoses and clinical characteristics. Post-index outcomes, including the number of buprenorphine orders and incidence of drug-related poisoning, were assessed for each class. Key Results In a cohort of 5726 individuals (mean age 38.6 years, 56.2% female, 84.0% white), four latent classes were identified: (1) high multimorbidity burden; (2) moderate multimorbidity burden; (3) high rates of comorbid pain diagnoses but lower rates of psychiatric and substance use disorder diagnoses, with most patients lacking opioid use disorder diagnoses; (4) lower rates of pain diagnoses but high rates of comorbid psychiatric and substance use disorder diagnoses. Post-index measures aligned well with comorbidity profiles. Conclusion Patients receiving buprenorphine in general healthcare settings likely form a heterogeneous group. This includes a subgroup with low rates of opioid use disorder diagnoses (class 2, pain comorbidity), who may resemble chronic pain patients more than conventional OUD patients.