TY - JOUR
KW - Adult
KW - Buprenorphine, Naloxone Drug Combination/administration & dosage
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Narcotic Antagonists/administration & dosage
KW - Opiate Substitution Treatment/statistics & numerical data
KW - Opioid-Related Disorders/drug therapy
KW - Outcome Assessment (Health Care)
KW - Patient Satisfaction
KW - Practice Guidelines as Topic
KW - Retrospective Studies
KW - Substance Abuse Detection/statistics & numerical data
KW - Urinalysis/statistics & numerical data
AU - Ryan Graddy
AU - Darius A. Rastegar
A1 - 
AB - OBJECTIVE: This study examines the impact of an insurance-mandated change in formulation of buprenorphine/naloxone (BNX) for patients with opioid use disorder treated in a primary care clinic. METHODS: A retrospective cohort study was conducted to determine the proportion of patients who were switched back to the previous BNX formulation and rates of aberrant urine drug tests for the 3 months before and 3 months after a mandated change in BNX from the sublingual film to the rapidly dissolving tablet (BNX-RDT). Aberrant urine drug tests were defined as the presence of cocaine, nonprescribed opioids/benzodiazepines, or the absence of buprenorphine. RESULTS: In all, 186 patients were included in the analysis. At 3 months after the change, 36.0% of patients remained on BNX-RDT at equivalent dose, 9.1% were prescribed a higher dose of BNX-RDT, 52.7% were switched back to their previous formulation after a trial of BNX-RDT, and 2.2% dropped out of care. There was no significant change in the rates of aberrant urine drug tests pre and postchange (36.6% vs 33.7%; P = 0.27) or in any individual component of urine drug testing. Age, sex, and starting dose were not associated with remaining on BNX-RDT at equivalent dose, compared with increasing dose or changing formulation. CONCLUSIONS: Most patients were dissatisfied with the change in formulation and requested a return to the previous formulation. This change did not appear to impact drug use; however, the flexibility that permitted patients to switch back to their previous BNX formulation likely attenuated the policy's impact.
AD - Division of Chemical Dependence, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD.
BT - Journal of addiction medicine
C5 - Opioids & Substance Use
CP - 6
CY - United States
DO - 10.1097/ADM.0000000000000341
IS - 6
JF - Journal of addiction medicine
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: This study examines the impact of an insurance-mandated change in formulation of buprenorphine/naloxone (BNX) for patients with opioid use disorder treated in a primary care clinic. METHODS: A retrospective cohort study was conducted to determine the proportion of patients who were switched back to the previous BNX formulation and rates of aberrant urine drug tests for the 3 months before and 3 months after a mandated change in BNX from the sublingual film to the rapidly dissolving tablet (BNX-RDT). Aberrant urine drug tests were defined as the presence of cocaine, nonprescribed opioids/benzodiazepines, or the absence of buprenorphine. RESULTS: In all, 186 patients were included in the analysis. At 3 months after the change, 36.0% of patients remained on BNX-RDT at equivalent dose, 9.1% were prescribed a higher dose of BNX-RDT, 52.7% were switched back to their previous formulation after a trial of BNX-RDT, and 2.2% dropped out of care. There was no significant change in the rates of aberrant urine drug tests pre and postchange (36.6% vs 33.7%; P = 0.27) or in any individual component of urine drug testing. Age, sex, and starting dose were not associated with remaining on BNX-RDT at equivalent dose, compared with increasing dose or changing formulation. CONCLUSIONS: Most patients were dissatisfied with the change in formulation and requested a return to the previous formulation. This change did not appear to impact drug use; however, the flexibility that permitted patients to switch back to their previous BNX formulation likely attenuated the policy's impact.
PP - United States
PY - 2017
SN - 1935-3227; 1932-0620
SP - 435
EP - 439
EP - 
T1 - Impact of a Mandated Change in Buprenorphine Formulation
T2 - Journal of addiction medicine
TI - Impact of a Mandated Change in Buprenorphine Formulation
U1 - Opioids & Substance Use
U2 - 28742624
U3 - 10.1097/ADM.0000000000000341
VL - 11
VO - 1935-3227; 1932-0620
Y1 - 2017
Y2 - Nov/Dec
ER -