August 15, 2019 – Patients receiving buprenorphine for treatment of opioid use disorder (OUD) are more likely to use medications for chronic, unrelated conditions, suggests a study in the September issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.
Increased adherence to treatments for accompanying (comorbid) conditions is especially important due to the high rates of mental illness and other medical conditions among individuals with OUD, according to the study by G. Caleb Alexander, MD, MS, and colleagues of Johns Hopkins Bloomberg School of Public Heath, Baltimore.
Use of Antidepressants and Other Medications Increases after Starting Buprenorphine
Using a US insurance claims database, the researchers identified approximately 12,700 patients with OUD who started treatment with buprenorphine between 2011 and 2015. Buprenorphine is effective in reducing opioid use and opioid-related overdoses, while improving social functioning and treatment retention. It is an important type of medication for addiction treatment (MAT), which can be used or without behavioral therapy to improve outcomes in patients with OUD.
The study focused on five categories of drugs used to treat chronic diseases that commonly occur among individuals with OUD: cholesterol-lowering drugs, antipsychotics, anti-seizure drugs, anti-diabetes drugs, and antidepressants. The researchers hypothesized that patients would be more likely to be treated for these comorbid diseases during periods when they were receiving buprenorphine.
Overall, about 5,600 of the OUD patients receiving buprenorphine had a prescription for at least one of the five medication classes. Antidepressants were the most commonly prescribed category, 37 percent of patients; followed by anti-seizure drugs (which can be used as mood stabilizers among individuals with bipolar affective disorder), 19 percent. Approximately six percent of patients with OUD receiving buprenorphine had a prescription for cholesterol-lowering drugs, 5.5 percent for anti-psychotics, and two percent for anti-diabetes drugs.
For all five medication classes, patients were more likely to have a supply of their prescribed drug on days when they also had buprenorphine on hand. The study included adjustment for other factors, including the patients' level of adherence to prescribed medications before starting buprenorphine.
On adjusted analysis, patients who had buprenorphine on hand were significantly more likely to have a supply of their prescribed antidepressants, anti-seizure drugs, and cholesterol-lowering drugs. For anti-psychotics and anti-diabetes drugs, the trend was in the same direction but not statistically significant.
The effect was largest for antidepressants, where the probability of having a prescribed antidepressant on hand increased from 54 percent without buprenorphine to 62 percent with buprenorphine.
"With more than 2.1 million Americans with active, past-year OUD, there remain pressing questions regarding how treatment access for OUD can be optimized, as well as the effect that such access may have on patients' overall quality of care," Dr. Alexander and coauthors write. With rising numbers of patients receiving buprenorphine and other forms of MAT, it's important to understand the impact on the treatment of common psychiatric and non-psychiatric illnesses that often accompany OUD.
The study suggests "potential spillover benefits," with buprenorphine facilitating greater treatment for chronic, unrelated conditions. While the study can't show any causal effect, the researchers speculate that patients starting evidence-based buprenorphine therapy for OUD "may experience improved organization and self-efficacy that could lead to better adherence to treatments for comorbid conditions."
Regular contact with the healthcare system might also play a role, along with other life circumstances related to starting treatment for OUD. Dr. Alexander comments: "Our findings are of both clinical and economic importance because there is a large, and growing, population with OUD in the United States, and their care needs extend far beyond opioid use disorder alone."
About Medical Care
Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association
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