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Chronic Disease Medication Adherence After Initiation of Buprenorphine for Opioid Use Disorder

Chang, Hsien-Yen PhD*,†; Daubresse, Matthew MHS†,‡; Saloner, Brendan PhD*,†; Alexander, G. Caleb MD, MS†,‡,§

doi: 10.1097/MLR.0000000000001165
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Background: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), it is unknown whether buprenorphine use may affect patients’ adherence to treatments for chronic, unrelated conditions.

Objectives: To quantify the effect of buprenorphine treatment on patient adherence to 5 therapeutic classes: (1) antilipids; (2) antipsychotics; (3) antiepileptics; (4) antidiabetics; and (5) antidepressants.

Research Design: This was a retrospective cohort study.

Subjects: We started with 12,719 commercially ensured individuals with a diagnosis of OUD and the buprenorphine initiation between January 2011 and June 2015 using Truven Health’s MarketScan data. Individuals using any of the 5 therapeutic classes of interest were included.

Measures: Within the 180-day period post buprenorphine initiation, we derived 2 daily indicators: having buprenorphine and having chronic medication on hand for each therapeutic class of interest. We applied logistic regression to assess the association between these 2 daily indicators, adjusting for demographics, morbidity, and baseline adherence.

Results: Across the 5 therapeutic classes, the probability with a given treatment on hand was always higher on days when buprenorphine was on hand. After adjustment for demographics, morbidity, and baseline adherence, buprenorphine was associated with a greater odds of adherence to antilipids [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.04–1.54], antiepileptics (OR, 1.22; CI, 1.10–1.36) and antidepressants (OR, 1.42; CI, 1.32–1.60).

Conclusions: Using buprenorphine to treat OUD may increase adherence to treatments for chronic unrelated conditions, a finding of particular importance given high rates of mental illness and other comorbidities among many individuals with OUD.

*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health

§Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD

G.C.A. is Chair of the US Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee; has served as a paid consultant to IQVIA and serves on the Advisory Board of MesaRx Innovations; holds equity in Monument Analytics, a health care consultancy whose clients include the life sciences industry and plaintiffs in opioid litigation; and serves as a member of OptumRx’s P&T Committee. This arrangement has been reviewed and approved by the Johns Hopkins Bloomberg School of Public Health. The remaining authors declare no conflict of interest.

Reprints: G. Caleb Alexander, MD, MS, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street W6035, Baltimore, MD 21205. E-mail: galexand@jhsph.edu.

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