INTRODUCTION: Higher buprenorphine maintenance doses (>24 mg daily) may be more effective in improving opioid use disorder (OUD) treatment outcomes in the era of fentanyl predominance. Evidence on maintenance dose trends remains limited, especially among vulnerable populations, who are disproportionately affected by opioid overdose deaths. The objective of this study was to describe trends in maintenance dose of buprenorphine for OUD and the association of social vulnerability with maintenance dose. METHODS: We identified buprenorphine treatment episodes initiated between January 2019 and June 2021 using the IQVIA Longitudinal Prescription database. Episodes were assigned to a maintenance dose category of 24 mg, to reflect dosages lower than, consistent with, or higher than the guideline-recommended target dose range, respectively. County-level social vulnerability was measured with the Minority Health Index (MHI). We used multinomial logistic regression with generalized estimating equations to test the association between MHI (stratified into quartiles) and maintenance doses 24 mg (with 16-24 mg as the reference group), adjusting for patient, geographic, and time characteristics. RESULTS: Of 1,044,460 treatment episodes among 543,326 individuals (mean SD age 41.9 12.6 years, 43% female), the most common buprenorphine maintenance dose category was 16-24 mg (62.7%), followed by 24 mg (2.8%). The median (IQR) episode duration was 64 (109) days. The proportion of episodes in the 24 mg category were in rural versus urban counties; the magnitude of this difference increased over time. Relative to 16-24 mg, maintenance dose >24 mg was more likely among individuals in the most vulnerable MHI quartile compared to the least vulnerable quartile (aOR 1.28, 95% CI 1.19-1.38). CONCLUSION: During a period of growing evidence supporting higher buprenorphine maintenance doses, the prevalence of treatment episodes with maintenance dose <16 mg increased. Individuals in the highest social vulnerability quartile tended to receive higher doses, suggesting that some higher-risk groups may receive more intensive treatment, even as important gaps remain. These results can inform efforts targeting equitable, high-quality buprenorphine prescribing.
Sabol et al. (Tue,) studied this question.