{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:33Z","timestamp":1788922173523,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Opioid use disorder (OUD) is treatable with buprenorphine\/naloxone (buprenorphine), but many patients discontinue treatment prematurely. The aim of this study was to assess the influence of patient\u2010 and prescriber\u2010level characteristics relative to several patient outcomes following the initiation of buprenorphine treatment for OUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a retrospective observational investigation. We used the Public Health Data Warehouse from the Massachusetts Department of Public Health to construct a sample of patients who initiated buprenorphine treatment between 2015 and 2019. We attributed each patient to a prescriber based on information from prescription claims. We used multilevel models to assess the influence of patient\u2010 and prescriber\u2010level characteristics on each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Massachusetts, USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study cohort comprised 37\u2009955 unique patients and 2146 prescribers. Among patients, 64.6% were male, 52.6% were under the age of 35 and 82.2% were White, non\u2010Hispanic. For insurance coverage, 72.1% had Medicaid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The outcome measures were poor medication continuity, treatment discontinuation and opioid overdose, all assessed within a 12\u2010month follow\u2010up period that began with a focal prescription for buprenorphine. Each patient had a single follow\u2010up period. Poor medication continuity was defined as medication gaps totaling more than 7\u00a0days during the initial 180\u2009days of buprenorphine treatment and treatment discontinuation was defined as having a medication gap for 2 consecutive months within the 12\u2010month follow\u2010up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The patient\u2010level rates for poor medication continuity, treatment discontinuation and opioid overdose were 59.7% [95% confidence interval (CI) = 59.2\u201360.2], 57.4% (95% CI = 56.9\u201357.9) and 10.3% (95% CI = 10.0\u201310.6), respectively, with 1.1% (95% CI = 1.0\u20131.2) experiencing a fatal opioid overdose. At the patient level, after adjustment for covariates, adverse outcomes were associated with race\/ethnicity as both Black, non\u2010Hispanic and Hispanic patients had worse outcomes than did White, non\u2010Hispanic patients (Black, non\u2010Hispanic \u2010\u2010 poor continuity: 1.50, 95% CI = 1.34\u20131.68; discontinuation: 1.44, 95% CI = 1.30\u20131.60; Hispanic \u2010\u2010 poor continuity: 1.21, 95% CI = 1.12\u20131.31; discontinuation: 1.38, 95% CI = 1.28\u20131.48). Patients with insurance coverage through Medicaid also had worse outcomes than those with commercial insurance (poor continuity: 1.18, 95% CI = 1.11\u20131.26; discontinuation: 1.09, 95% CI = 1.03\u20131.16; overdose: 1.98, 95% CI = 1.75\u20132.23). Pre\u2010treatment mental health conditions and other types of chronic illness were also associated with worse outcomes (History of mental health conditions \u2010\u2010 poor continuity: 1.11, 95% CI = 1.06\u20131.17; discontinuation: 1.05, CI = 1.01\u20131.10; overdose: 1.47, 95% CI = 1.36\u20131.60; Chronic health conditions \u2010\u2010 poor continuity: 1.15, 95% CI = 1.05\u20131.27; discontinuation: 1.15, 95% CI = 1.05\u20131.26; overdose: 1.83, 95% CI = 1.60\u20132.10; History of substance use disorder other than for opioids \u2010\u2010 poor continuity: 1.54, 95% CI = 1.46\u20131.62; discontinuation: 1.54, 95% CI = 1.47\u20131.62; overdose: 1.93, 95% CI = 1.80\u20132.07). At the prescriber level, after adjustments for covariates, adverse outcomes were associated with clinical training, as primary care physicians had higher rates of adverse outcomes than psychiatrists (poor continuity: 1.12, 95% CI = 1.02\u20131.23; discontinuation: 1.04, 95% CI = 1.01\u20131.09). A larger prescriber panel size, based on number of patients being prescribed buprenorphine, was also associated with higher rates of adverse outcomes (poor continuity: 1.36, 95% CI = 1.27\u20131.46; discontinuation: 1.21, 95% CI = 1.14\u20131.28; overdose: 1.10, 95% CI = 1.01\u20131.19). Between 9% and 15% of the variation among patients for the outcomes was accounted for at the prescriber level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patient\u2010 and prescriber\u2010level characteristics appear to be associated with patient outcomes following buprenorphine treatment for opioid use disorder. In particular, patients' race\/ethnicity and insurance coverage appear to be associated with substantial disparities in outcomes, and prescriber characteristics appear to be most closely associated with medication continuity during early treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16684","type":"journal-article","created":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T23:59:47Z","timestamp":1728863987000},"page":"152-163","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Patient outcomes following buprenorphine treatment for opioid use disorder: A retrospective analysis of the influence of patient\u2010 and prescriber\u2010level characteristics in Massachusetts, USA"],"prefix":"10.1111","volume":"120","author":[{"given":"Gary J.","family":"Young","sequence":"first","affiliation":[{"name":"Center for Health Policy and Healthcare Research Northeastern University  Boston MA 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for Health Policy and Healthcare Research Northeastern University  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard D.","family":"Young","sequence":"additional","affiliation":[{"name":"Prescription Monitoring Program Massachusetts Department of Public Health  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5353-9710","authenticated-orcid":false,"given":"Md.","family":"Noor\u2010E\u2010Alam","sequence":"additional","affiliation":[{"name":"Center for Health Policy and Healthcare Research Northeastern University  Boston MA USA"},{"name":"Department of Mechanical and Industrial Engineering Northeastern University  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,13]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Opioid use disorder [Internet]","author":"American Psychiatric 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