Buprenorphine Dose and Treatment Outcomes: is 16 mg/day Enough? (1 CME)

Office-based treatment for opioid dependence with buprenorphine has expanded access to treatment for individuals with opioid use disorders and has proven to be effective in a variety of settings. However, despite over 10 years of experience, there are still questions about the optimal dose for buprenorphine treatment. In this focus session, we will review existing evidence from the literature about the relationship between buprenorphine dose and physiologic measures and patient outcomes. Early studies suggested that doses of 8 to 16 mg per day of the the sublingual formulation should be sufficient and some insurers have limited access to doses higher that 16 mg/day as a result. Some guidelines have discouraged use of doses higher than 16 mg/day. However, there is growing clinical data that suggests that higher doses may lead to improved treatment retention and outcomes. This includes a recent study that we have conducted that specifically addressed this question. ¨The focus session with then conclude with an opportunity for discussion about optimal buprenorphine dosing for outpatient practice and methods for studying it. In this discussion, the relative risks and benefits of dose limits will be considered. Tension may exist between the goal of increasing treatment retention and the goal of minimizing drug diversion and cost, and these factors will be considered.