The association between buprenorphine doses above 16 milligrams and treatment retention in a multi‐payer national sample in the United States, 2014 to 2021
Bibliographic record
Abstract
BACKGROUND AND AIMS: Buprenorphine-naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40 mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine-naloxone doses between 4 and 40 mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40 mg doses. DESIGN: Observational cohort study in a national, multi-payer sample of prescription claims (IQVIA) of episodes involving buprenorphine-naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180 days. New episodes started with a 14+ day gap between prescriptions. SETTING: United States of America. PARTICIPANTS: The sample involved 620 229 episodes across 498 879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine-naloxone for OUD. MEASUREMENTS: The exposure was the maximum daily dose of buprenorphine-naloxone reached in the first 30 days of an episode, ranging from 4 to 40 mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18 months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation. FINDINGS: Daily doses of 24, 32 and 40 mg increased retention compared with 16 mg at 1-18 months [adjusted odds ratio (aOR) range = 1.17; 95% confidence interval (CI) = 1.14, 1.20 at 18 months to 1.52 (CI = 1.49, 1.54) at 1 month, both for 24 mg]. In pairwise comparisons, 32 mg was favorable to 24 mg at 6, 12 and 18 months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12 months; aOR = 1.12 (95% CI = 1.06, 1.19) at 18 months], and 40 mg was favorable to 24 mg at 12 and 18 months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months]. CONCLUSIONS: Daily buprenorphine-naloxone doses of 24 mg appear to be associated with increased treatment retention compared with 16 mg and, for 6+ month episodes, 32 and 40 mg appear to be associated with increased retention compared with 24 mg.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".