Multiple Pharmacies, Prescribers Increase Likelihood of Buprenorphine Initiation in Patients Receiving Opioid Analgesics

Patients receiving opioid analgesics who had multiple prescribers or pharmacies were more likely to receive outpatient sublingual buprenorphine for addiction, according to a study published in PLOS One. 

“This finding suggests that patients with multiple healthcare interactions are more likely to be treated for high-risk opioid use,” researchers wrote, “or may be more likely to be identified and treated for addiction.” 

Researchers tapped data from the North Carolina Prescription Drug Monitoring Program to identify 4.3 million people prescribed opioid analgesics in the state between 2011 and 2015. They were interested specifically in identify predictors of sublingual buprenorphine initiation. 

Nearly 29,000 patients prescribed opioid analgesic therapy initiated buprenorphine intended for addiction treatment, researchers wrote. Predictors of buprenorphine initiation were the use of three or more pharmacies or six or more controlled substance prescribers. 

Cumulative exposure to opioids was associated with an increased likelihood of buprenorphine initiation, the study found.  

In addition, researchers were surprised to find that buprenorphine initiation was less likely among patients dispensed benzodiazepines.

“Unfortunately, our data cannot elucidate why benzodiazepine exposure may be protective of buprenorphine initiation,” researchers wrote. “Benzodiazepines may be considered an informal clinical contraindication for buprenorphine, or they may suggest comorbidity between pain and anxiety or sleep disorders for which benzodiazepines are routinely prescribed, or some other unobserved factor. It also may be an indicator of patient characteristics associated with low coordination between multiple providers.” 

—Jolynn Tumolo

Reference

Alexandridis AA, Dasgupta N, Ringwalt CL, Rosamond WD, Chelminski PR, Marshall SW. Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data [published online January 10, 2020]. PLoS One. 2020;15(1):e0227350. doi:10.1371/journal.pone.0227350