biostudies-literatureMorgan JRNCIPC CDC HHSNIDA NIH HHSACL HHSNIAID NIH HHSNational Center for Injury Prevention and ControlNational Institutes of HealthNational Institute on Drug Abuse108764https://www.ebi.ac.uk/biostudies/studies/S-EPMC8488795biostudies-literatureUnknown225<h4>Background and aims</h4>While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort.<h4>Setting</h4>United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone.<h4>Measurements</h4>Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose.<h4>Findings</h4>We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment.<h4>Conclusions</h4>Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.Drug and alcohol dependenceCharacterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort.PMC8488795R01 CE002999P30 AI042853K23 DA044085R01 DA046527K23DA044085P30DA040500R01CE002999P30 DA040500R01046527Hadland SELinas BPBarocas JMurphy SMAssoumou SAChatterjee AWalley AYMorgan JRfalseCharacterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort.<h4>Background and aims</h4>While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort.<h4>Setting</h4>United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone.<h4>Measurements</h4>Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose.<h4>Findings</h4>We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment.<h4>Conclusions</h4>Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.2021-01-01T00:00:00Z2021 Aug2025-04-26T16:36:05.023Z2025-04-06T15:13:11.379ZS-EPMC84887953405154710.1016/j.drugalcdep.2021.108764