Objective: Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. Adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum.
Methods: A retrospective longitudinal cohort analysis was performed using the MarketScan multistate Medicaid claims database (2013–2017), covering 12 million beneficiaries annually. The sample included adults (18–64 years of age) who received buprenorphine continuously for ≥180 days by cohorts retained for 6–9 months, 9–12 months, 12–15 months, and 15–18 months. For outcome assessment in the postdiscontinuation period, patients had to be continuously enrolled in Medicaid for 6 months after buprenorphine discontinuation. Primary adverse outcomes included all-cause emergency department visits, all-cause inpatient hospitalizations, opioid prescriptions, and drug overdose (opioid or non-opioid).
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The participant will identify outcomes associated with buprenorphine discontinuation for the treatment of opioid use disorder based on duration of care.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Estimated Time to Complete
Duration: 1 hour
Begin Date: February 1, 2020
End Date: January 31, 2022
How to Earn Credit
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
Title: Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder
Authors: Arthur Robin Williams, M.D., M.B.E., Hillary Samples, Ph.D., Stephen Crystal, Ph.D., Mark Olfson, M.D., M.P.H.
Affiliations: Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York (A.R.W., M.O.); Department of Epidemiology, Columbia University Mailman School of Public Health, New York (H.S.); and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, N.J. (S.C.).
Disclosures: Dr. Samples has received consulting fees from the American Society for Addiction Medicine. The other authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.
Optimal System Configuration:
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