Higher Doses of Buprenorphine Needed for Effective Opioid Addiction Treatment, Experts Say
Consensus Grows for Higher Doses of Buprenorphine
Consensus is growing around the idea that for some patients, higher doses of a gold-standard opioid addiction treatment drug may be better than lower doses at keeping patients healthy and in treatment, especially for those who use fentanyl.
Limitations Around Buprenorphine Prescribing
But whether someone can access higher doses of buprenorphine, which works by curbing cravings and withdrawal from opioids, depends on where they live. In most states, Medicaid, the largest payer of substance use disorder treatment in the U.S., caps the doses it will pay for at arbitrary levels, typically at no more than 24 milligrams.
Underdosing: A Risk to Patient Health
In some states, like Tennessee, that level is as low as 16 milligrams. With “underdosing,” patients may experience symptoms that could push a person back toward the drugs they’re trying to quit, risking overdose or even death.
Providers Say Higher Doses are Necessary
Providers say higher doses, sometimes up to 32 milligrams, are necessary in the face of a drug supply dominated by highly potent fentanyl.
Medicaid Programs Limit Access to Higher Doses
TennCare, Tennessee’s Medicaid program, won’t pay for doses higher than 16 milligrams except in limited circumstances. "If you’re on a limit of 16 milligrams and cravings aren’t being controlled, you’re inadequately managing their disease," said Ryan Alexander, addiction medicine physician and medical director for substance use programming at McNabb Center in Knoxville, Tenn. "That puts them at risk of relapse and overdose."
Studies Support Higher Doses
Several recent studies have shown dosage limits may be standing in the way of better care. A study published last month in JAMA Network Open found that adults with opioid use disorder who received buprenorphine doses higher than 24 milligrams had a lower risk of emergency department visits or inpatient visits related to behavioral health.
Conclusion
The growing consensus among experts is that higher doses of buprenorphine are necessary to effectively treat opioid addiction, especially in the face of a drug supply dominated by potent fentanyl. However, Medicaid programs and insurance companies are hesitant to pay for doses above 24 milligrams, citing FDA labeling guidelines. Nevertheless, providers and patients may face a design hole in getting the treatment they need, putting them at risk of relapse and overdose.
FAQs
Q: Why are higher doses of buprenorphine necessary?
A: Higher doses of buprenorphine are necessary to effectively curb cravings and withdrawal symptoms in patients with opioid use disorder, especially in the face of a drug supply dominated by potent fentanyl.
Q: Why do Medicaid programs limit dosing?
A: Medicaid programs limit dosing to levels as low as 24 milligrams, citing FDA labeling guidelines, which state that dosages higher than 24 milligrams have not been demonstrated to provide any clinical advantage.
Q: What is the current state of the drug supply?
A: The current drug supply is dominated by highly potent fentanyl, which requires higher doses of buprenorphine to effectively treat opioid use disorder.
