(88) Higher Buprenorphine Dose Associated with Treatment Retention at Low-Threshold Clinic

Title: Higher buprenorphine dose associated with treatment retention at low-threshold clinic

Introduction: There is controversy regarding effective sublingual buprenorphine dosing for treatment of opioid use disorder (OUD), leading to dose caps of 16 mg per day at many programs despite uncertain evidence. The Project Connections at Re-Entry (PCARE) program is a low-threshold mobile clinic operated by the Behavioral Health Leadership Institute that provides medication for opioid use disorder (MOUD) to vulnerable populations in Baltimore City.

Methods: This analysis includes clinical patients who received buprenorphine at PCARE between January 2021 and July 2021 and examines differences in demographic characteristics and treatment outcomes by buprenorphine dose (16 mg or >16 mg).

Results: In the study period, 566 patients received buprenorphine treatment at the PCARE van. Patients were primarily male (71.0%), Black (89.4%), had a mean age of 46.3 years (SD = 11.5), and a mean opioid use of 22.1 years (SD = 13.4). The majority had previous criminal justice involvement (73.9%), had Medicaid insurance coverage (75.4%), and were unemployed (69.6%). Nearly half of the sample had reported a previous overdose event (48.4%). There were no significant demographic differences between patients receiving 16 mg of buprenorphine per day compared to patients receiving >16 mg. Patients receiving >16 mg had significantly higher odds of treatment retention at 30- and 90-days: OR=2.5 (1.12, 5.57) p=0.03, and OR=2.15 (1.3, 3.56) p=0.003, respectively.

Conclusions: In this study examining patients with OUD in a low-threshold mobile buprenorphine clinic, we observed higher rates of treatment retention with buprenorphine doses >16 mg.

References: 1. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S):1-91. doi:10.1097/ADM.0000000000000633

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3. Krawczyk N, Buresh M, Gordon MS, Blue TR, Fingerhood MI, Agus D. Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap. J Subst Abuse Treat. 2019;103:1-8. doi:10.1016/j.jsat.2019.05.002

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Diversity, Equity, and Inclusion: The global aims of this study are to evaluate effective dosing strategies for treating OUD in a population that is highly marginalized due to criminal justice involvement, housing instability, and public insurance coverage. Health equity is a major focus of the PCARE program, and as such, the program focuses on providing evidence-based treatment in a low barrier setting to a patient population that has difficulty accessing substance use treatment in traditional settings. In fact, PCARE has been very successful at reaching Black Americans (88% of program patients), a group that is less likely to receive buprenorphine.