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So You Prescribed Suboxone : Do Patients Really Take It?

So You Prescribed Suboxone : Do Patients Really Take It?. Discussion of Patient A dherence to Suboxone / Burprenorphine Regimens. Teresa Hudson, PharmD , PhD Associate Professor, Department of Psychiatry. CE Credits: TEXT: 501-406-0076 Activity Code: 29473-24581. NO Disclosures.

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So You Prescribed Suboxone : Do Patients Really Take It?

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  1. So You Prescribed Suboxone: Do Patients Really Take It? Discussion of Patient Adherence to Suboxone/Burprenorphine Regimens Teresa Hudson, PharmD, PhD Associate Professor, Department of Psychiatry CE Credits: TEXT: 501-406-0076 Activity Code: 29473-24581

  2. NO Disclosures CE Credits: TEXT: 501-406-0076 Activity Code: 29473-24581

  3. Set Up for Using Poll Everywhere • Text to this number: 22333 • Text this message: Teresahudson735

  4. Objectives • Discuss importance of buprenorphine adherence • Discuss current data on rates of adherence to buprenorphine regimens and identify factors that influence adherence • Compare data on buprenorphine adherence to data on medication adherence for other chronic diseases • Identify strategies that may be helpful in assessing and improving adherence

  5. Buprenorphine - opioid medication • Unique because it is a partial agonist : • Less euphoria and physical dependence • Lower potential for abuse • Used primarily to treat opioid use disorder • Other medication assisted treatments (MAT) for OUD include: methadone and extended release naltrexone • Typically used as chronic medication • Available in multiple dosage forms (buprenorphine only): • Injectable • Sublingual tablet • Buccal film • Transdermal patch • Intradermal implant • Combined with naloxone • Sublingual film or tablet • Brand names: Bunavail, Suboxone, Zubsolve • Can be prescribed by a physician/nurse practitioner/physician’s assistant who have received an FDA Waiver

  6. MAT decreases mortality among individuals with OUD: Data from 21 Pooled Studies All Cause Mortality Rate per 100 person years Ma et al Molecular Psychiatry 2018

  7. MAT decreases mortality from overdose among individuals with OUD: Data from 16 pooled Studies Overdose Mortality Rate per 100 person years Ma et al Molecular Psychiatry 2018

  8. MAT-specific Mortality rates All Cause Mortality Rate per 100 person years Ma et al Molecular Psychiatry 2018

  9. Buprenorphine may improve neuropsychological function among individuals with OUD? • Small study of 20 adults with OUD who were treated with buprenorphine/naloxone • All were newly prescribed buprenorphine/naloxone • Buprenorphine induction at a community-based clinic then maintained on 4-16 mg of buprenorphine/naloxone x 6 months • Neuropsychological testing at baseline and six months assessed: • Depressive symptoms • Buprenorphine-naloxone adherence • Substance use disorder • Neuropsychological functioning

  10. Results: Population Characteristics Scott et al substance Abuse treatment Prevention, and Policy 2017

  11. Change in Depressive Symptoms and Neuropsychological (NP) Functioning

  12. Key findings • No significant change overall baseline compared with follow up for NP or depressive symptoms • Correlation between greater adherence to buprenorphine/naloxone and : • improved learning (r=.52, p=.019) • Improved Memory (r=.59, p=.006) • Improved global functioning (r=.6, p=.008) Scott et al substance Abuse treatment Prevention, and Policy 2017

  13. Buprenorphine may decrease healthcare utilization and costs among people with OUD • Analyses from claims from commercially insured and Medicaid recipients • 2008-2014 • Adherence was based on proportion of days covered (PDC) • Full adherence was defined as filling buprenorphine prescriptions to cover 80% of the 1 year observation period for each patient • PDC= Sum of days supply in 12 month observation period 365 • Overall Adherence Rate: • 37.1 Commercial Cohort PDC >/=.8 • 41.3 Medicaid cohort PDC >/=.8 Ronquest et al substance abuse and rehabilitation 2018

  14. Ronquest et al substance abuse and rehabilitation 2018

  15. Service utilization: Commercial Cohort Ronquest et al substance abuse and rehabilitation 2018 * P<.001

  16. Healthcare Costs: Commercial Cohort Ronquest et al substance abuse and rehabilitation 2018 * P<.001

  17. Factors associated with buprenorphine adherence Ronquest et al substance abuse and rehabilitation 2018

  18. Other Factors Associated with Adherence to Buprenorphine: • Race: • Some studies suggest that black race may be associated with non-adherence or discontinuation even when among patients who have similar insurance coverage • Physical Health • Higher levels of physical health comorbidities may be associated with non-adherence or discontinuation • MH and SUD comorbidities • Depression and bipolar disorder - increased severity Comorbid non-opioid sud - particularly alcohol • Buprenorphine dose: • At least two studies have found that lower buprenorphine dose is associated with lower levels of adherence • Severity of opioid withdrawal symptoms • One study examined this in pregnant women and found that more severe withdrawal symptoms were associated with greater risks of non-adherence

  19. Comparison with Physical Health Medication Adherence

  20. Additional References • Brown MT, Bussell JK. Mayo Clinic Proceedings 2011;886(4):304-314 • Coker JL, Catlin D, Ray-Griffith S, Knight B, Stowe ZN. Drug and Alcohol Dependence 2018 192:146-149 • Kumari S, Manalai P, Leong S, Wooditch A, Mansoor M, Lawson W. The American Journal on Addictions 2016 25:110-117 • Litz M, Leslie D. The American Journal on Addictions 2017 26:859-863 • Manhapra A, Petrakis I, Rosenheck R. American Journal on Addictions 2017 26:572-280 • Ronquest NA, Willson TM, Montejano LB, Nadipelli VR, Wollschlaeger BA. Substance Abuse and Rehabilitation 2018:9, 59-78

  21. Want the Panel to Discuss a Case Anonymously? Submit to AR-IMPACT@uams.edu More Information: http://arimpact.uams.edu/ CE Credits: TEXT: 501-406-0076 Activity Code: 29473-24581

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