Stein Bradley D, Sheng Flora, Saloner Brendan K, Gordon Adam J, Merlin Jessica S
RAND, Pittsburgh, PA, USA.
RAND, Arlington, VA, USA.
Addict Sci Clin Pract. 2025 Apr 9;20(1):33. doi: 10.1186/s13722-025-00547-0.
In response to greater illicit fentanyl use, buprenorphine daily doses exceeding the FDA's recommended target daily dose (16 mg) and maximum suggested daily dose (24 mg) may provide better outcomes, but little is known about higher dosage prescribing patterns. To better understand buprenorphine prescribing patterns, this manuscript examines the frequency and characteristics of dispensed buprenorphine of ≤ 16mg, > 16-24 mg, and > 24 mg daily dose.
We used IQVIA data to conduct a cross-sectional study of opioid use disorder-indicated buprenorphine prescriptions dispensed at retail pharmacies January 2019 - December 2020; categorized prescriptions as ≤ 16mg, > 16 to 24 mg, and > 24 mg daily dose; and examined overall rates and rates by patient, insurer and county characteristics, and prescriber specialty. We categorized buprenorphine prescriptions by patient sex, age cohort, primary payment source, and prescriber specialty and state and conducted univariate and bivariate analyses of buprenorphine daily dose categories overall and among clinicians frequently prescribing buprenorphine at the highest doses, > 24 mg.
Approximately 19.5% (n = 5,568,964) of the 28 million buprenorphine prescriptions from 68,898 clinicians were > 16-24 mg; 2% (n = 641,390) were > 24 mg. Approximately 26% (n = 17,939) of clinicians wrote at least one prescription > 24 mg; 2,780 clinicians (4% of buprenorphine prescribers) were responsible for 82.2% (n = 527,597) of dispensed prescriptions > 24 mg. 28% of prescriptions > 24 mg written by these prescribers were cash-pay, 12.5% covered by Medicaid, and 6.7% covered by Medicare. There was no correlation between state fentanyl overdose rate and buprenorphine prescriptions > 24 mg per 1,000,000 residents.
In 2019-2020, fewer than 3% of dispensed buprenorphine prescriptions exceeded the FDA suggested maximum of 24 mg daily dose; 80% of the prescriptions for a > 24 mg daily dose were written by 4% of buprenorphine prescribers. As clinicians and policymakers pay greater attention to ensuring individuals are receiving buprenorphine dosages adequate to effectively treat their opioid use disorder, the recently revised FDA recommendations may encourage such behavior. Additionally, disproportionate reliance on cash payment for higher daily doses suggests public and private insurers could facilitate access to such treatment when appropriate.
为应对非法芬太尼使用量的增加，丁丙诺啡每日剂量超过美国食品药品监督管理局（FDA）推荐的目标每日剂量（16毫克）和最大建议每日剂量（24毫克）可能会带来更好的治疗效果，但对于更高剂量的处方模式知之甚少。为了更好地了解丁丙诺啡的处方模式，本论文研究了每日剂量≤16毫克、>16 - 24毫克和>24毫克的丁丙诺啡配药频率及特征。
我们使用艾昆纬（IQVIA）的数据，对2019年1月至2020年12月在零售药店配出的用于治疗阿片类物质使用障碍的丁丙诺啡处方进行横断面研究；将处方按每日剂量分为≤16毫克、>16至24毫克和>24毫克三类；并按患者、保险公司、县特征以及开处方者专业进行总体比率及比率分析。我们按患者性别、年龄组、主要支付来源、开处方者专业、所在州对丁丙诺啡处方进行分类，并对丁丙诺啡每日剂量类别进行单变量和双变量分析，总体分析以及在经常开具最高剂量（>24毫克）丁丙诺啡的临床医生中进行分析。
来自68898名临床医生的2800万份丁丙诺啡处方中，约19.5%（n = 5568964）为>16 - 24毫克；2%（n = 641390）为>24毫克。约26%（n = 17939）的临床医生开具过至少一份>24毫克的处方；2780名临床医生（占丁丙诺啡开处方者的4%）开具了82.2%（n = 527597）的>24毫克配出处方。这些开处方者开具的>24毫克处方中，28%为现金支付，12.5%由医疗补助计划覆盖，6.7%由医疗保险覆盖。各州芬太尼过量使用率与每百万居民中>24毫克的丁丙诺啡处方数之间无相关性。
在2019 - 2020年，配出的丁丙诺啡处方中不足3%超过FDA建议的每日最大剂量24毫克；每日剂量>24毫克的处方中，80%由4%的丁丙诺啡开处方者开具。随着临床医生和政策制定者更加关注确保个体接受足以有效治疗其阿片类物质使用障碍的丁丙诺啡剂量，FDA最近修订的建议可能会鼓励这种行为。此外，高每日剂量对现金支付的过度依赖表明，公共和私人保险公司在适当时可促进获得此类治疗。
