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Higher-than-recommended buprenorphine doses were linked to fewer behavioral health-related ED or inpatient visits in patients with opioid use disorder.

Patients with opioid use disorder (OUD) prescribed buprenorphine at doses higher than recommended by the FDA have a lower risk for subsequent behavioral health-related emergency department (ED) or inpatient service use, according to a study published in JAMA Network Open.

“These results suggest that higher doses of buprenorphine are associated with lower acute care utilization and could provide benefits to patients, particularly those using fentanyl who might need these higher doses,” wrote corresponding author Bradley D. Stein, MD, PhD, and colleagues.

The FDA recommends a buprenorphine target dose of 16 mg per day, yet a handful of observational studies have found that daily doses above 24 mg are associated with longer treatment episodes and lower relapse, the researchers explained. This retrospective analysis investigated how higher doses affected behavioral health-related acute care utilization in 35,451 US adults with an OUD diagnosis. Investigators used deidentified data for patients with commercial insurance from the Optum Clinformatics Data Mart Database from  2016 to 2021.

The study grouped maximum buprenorphine daily doses, which patients received for 14 days or more, as follows: more than 24 mg, more than 16 mg to 24 mg, more than 8 mg to 16 mg, or 1 mg to 8 mg.

The most common maximum dose was more than 8 mg to 16 mg daily, which was prescribed to 14,802 patients, according to the study. Additionally, 9,669 patients were prescribed 1 mg to 8 mg daily, 10,329 were prescribed more than 16 mg to 24 mg daily, and 651 were prescribed more than 24 mg daily.

ED or inpatient visits for a behavioral health diagnosis were experienced by 12.5% of patients, the study found. The time between initiated maximum buprenorphine dose and ED or inpatient visits was longer for patients receiving doses above 24 mg and above 16 mg to 24 mg than for patients receiving FDA-recommended doses of 8 mg to 16 mg.

“These findings contribute to the sparse empirical research regarding potential benefits of higher-dose buprenorphine treatment of individuals with OUD,” the researchers wrote. “Clinicians should be aware of the potential effects of higher buprenorphine doses on healthcare utilization while policymakers work to ensure equitable access to individuals who could potentially benefit from higher doses.”