{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:24:31Z","timestamp":1791854671717,"version":"4.3.4"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Higher buprenorphine doses may benefit the increasing number of individuals using fentanyl and other synthetic opioids, but there is little empirical evidence on the efficacy of such higher doses.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between higher buprenorphine doses (above 16 mg and 24 mg) and subsequent emergency department (ED) or inpatient service use among patients diagnosed with opioid use disorder.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study was a retrospective analysis of health data from Optum\u2019s deidentified Clinformatics Data Mart Database from 2016 to 2021 for commercially insured individuals aged 18 years or older diagnosed with opioid use disorder (OUD). Eligible participants initiated buprenorphine after at least 90 days of enrollment and were dispensed at least a 14-day supply of buprenorphine. Data were analyzed from September 2023 through February 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Maximum buprenorphine dose received by a patient for 14 or more days: more than 24 mg, more than 16 mg to 24 mg, more than 8 mg to 16 mg, or 1 mg to 8 mg.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Days from initiation of the maximum buprenorphine dose to an ED or inpatient visit for a behavioral health diagnosis, controlling for patient demographics, comorbid conditions, time to reaching maximum dose, buprenorphine discontinuation, and pre-buprenorphine health care utilization.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 35\u202f451 individuals with an OUD diagnosis who began buprenorphine treatment were identified (mean [SD] age, 46.2 [15.1] years; 20\u202f983 male [59.2%]; 3326 Black [9.4%], 2411 Hispanic [6.8%], 26\u202f712 White [75.3%]). The most common dose was more than 8 mg to 16 mg daily (14\u202f802 patients [42.9%]), with 9669 patients (27.3%) in the 1 mg to 8 mg tier, 10\u202f329 patients (29.1%) in the 8 mg to 16 mg tier, and 651 patients (1.8%) in the tier receiving more than 24 mg. Among all patients receiving buprenorphine, 12.5% experienced an ED or inpatient visit. Survival analysis shows patients receiving doses more than 24 mg and between 16 mg to 24 mg had longer times to ED or inpatient use than patients receiving from 8 mg to 16 mg (time ratio [TR], 1.11; 95% CI, 1.02 to 1.20) and more than 24 mg (TR, 1.37; 95% CI, 1.04 to 1.81). Findings for doses above 16 mg daily were consistent for observation windows as short as 365 days (more than 24 mg: TR, 1.48; 95% CI, 1.01-2.18; more than 16 mg to 24 mg: TR, 1.19; 95% CI, 1.06-1.32).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings contribute to the sparse empirical research regarding potential benefits of higher-dose buprenorphine treatment of individuals with OUD. Clinicians should be aware of the potential effects of higher buprenorphine doses on health care utilization while policymakers work to ensure equitable access to individuals who could potentially benefit from higher doses.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.35478","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T17:40:49Z","timestamp":1727286049000},"page":"e2435478","source":"Crossref","is-referenced-by-count":23,"title":["Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization"],"prefix":"10.1001","volume":"7","author":[{"given":"Sarah","family":"Axeen","sequence":"first","affiliation":[{"name":"Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles"},{"name":"Department of Emergency Medicine, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie Liccardo","family":"Pacula","sequence":"additional","affiliation":[{"name":"Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles"},{"name":"Department of Health Policy and Management, Sol Price School of Policy, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica S.","family":"Merlin","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"},{"name":"Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley D.","family":"Stein","sequence":"additional","affiliation":[{"name":"RAND, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,9,25]]},"reference":[{"key":"zoi241056r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2022.100052","article-title":"What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? 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