{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:24:05Z","timestamp":1787822645185,"version":"build-2784847793"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000038","name":"U.S. Food and Drug Administration","doi-asserted-by":"publisher","award":["U01FD007064"],"award-info":[{"award-number":["U01FD007064"]}],"id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Buprenorphine\u2010naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40\u2009mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine\u2010naloxone doses between 4 and 40\u2009mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40\u2009mg doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort study in a national, multi\u2010payer sample of prescription claims (IQVIA) of episodes involving buprenorphine\u2010naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180\u2009days. New episodes started with a 14+\u2009day gap between prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>United States of America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The sample involved 620\u2009229 episodes across 498\u2009879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine\u2010naloxone for OUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The exposure was the maximum daily dose of buprenorphine\u2010naloxone reached in the first 30\u2009days of an episode, ranging from 4 to 40\u2009mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18\u2009months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Daily doses of 24, 32 and 40 mg increased retention compared with 16\u2009mg at 1\u201318\u2009months [adjusted odds ratio (aOR)\u00a0range = 1.17;\u00a095% confidence interval (CI) = 1.14, 1.20\u00a0at 18\u2009months to 1.52 (CI = 1.49, 1.54) at 1\u00a0month, both for 24\u2009mg]. In pairwise comparisons, 32\u2009mg was favorable to 24 mg at 6, 12 and 18\u2009months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12\u2009months;\u00a0aOR = 1.12 (95% CI = 1.06, 1.19) at 18\u2009months], and 40\u2009mg was favorable to 24\u00a0mg at 12 and 18\u2009months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Daily buprenorphine\u2010naloxone doses of 24\u2009mg appear to be associated with increased treatment retention compared with 16\u2009mg and, for 6+ month\u00a0episodes, 32 and 40\u2009mg appear to be associated with increased retention compared with 24\u2009mg.<\/jats:p>\n                  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