OBJECTIVE Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. Adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum. METHODS A retrospective longitudinal cohort analysis was performed using the MarketScan multistate Medicaid claims database (2013-2017), covering 12 million beneficiaries annually. The sample included adults (18-64 years of age) who received buprenorphine continuously for ≥180 days by cohorts retained for 6-9 months, 9-12 months, 12-15 months, and 15-18 months. For outcome assessment in the postdiscontinuation period, patients had to be continuously enrolled in Medicaid for 6 months after buprenorphine discontinuation. Primary adverse outcomes included all-cause emergency department visits, all-cause inpatient hospitalizations, opioid prescriptions, and drug overdose (opioid or non-opioid). RESULTS Adverse events were common across all cohorts, and almost half of patients (42.1%-49.9%) were seen in the emergency department at least once. Compared with patients retained on buprenorphine for 6-9 months (N=4,126), those retained for 15-18 months (N=931) had significantly lower odds of emergency department visits (odds ratio=0.75, 95% CI=0.65-0.86), inpatient hospitalizations (odds ratio=0.79, 95% CI=0.64-0.99), and filling opioid prescriptions (odds ratio=0.67, 95% CI=0.56-0.80) in the 6 months following discontinuation. Approximately 5% of patients across all cohorts experienced one or more medically treated overdoses. CONCLUSIONS Risk of acute care service use and overdose were high following buprenorphine discontinuation irrespective of treatment duration. Superior outcomes became significant with treatment duration beyond 15 months, although rates of the primary adverse outcomes remained high.

中文翻译：

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停止长期丁丙诺啡治疗阿片类药物使用障碍后的急性护理、处方阿片类药物使用和过量服用。

目标 尽管丁丙诺啡治疗可降低阿片类药物使用障碍患者的用药过量和死亡风险，但大多数患者会在数周或数月内停止治疗。在成功保留超过 6 个月连续治疗（最近由国家质量论坛认可的最短治疗持续时间）的患者中，比较了停用丁丙诺啡后的不良健康结果。方法 使用 MarketScan 多州医疗补助索赔数据库 (2013-2017) 进行回顾性纵向队列分析，每年覆盖 1200 万受益人。样本包括由保留 6-9 个月、9-12 个月、12-15 个月和 15-18 个月的队列连续接受丁丙诺啡≥180 天的成年人（18-64 岁）。对于停药后期间的结果评估，在停用丁丙诺啡后，患者必须连续加入医疗补助计划 6 个月。主要不良结局包括全因急诊就诊、全因住院、阿片类药物处方和药物过量（阿片类药物或非阿片类药物）。结果 不良事件在所有队列中都很常见，几乎一半的患者 (42.1%-49.9%) 至少在急诊科就诊过一次。与保留丁丙诺啡 6-9 个月的患者 (N=4,126) 相比，保留 15-18 个月的患者 (N=931) 急诊就诊的几率显着降低（几率比 = 0.75，95% CI = 0.65-0.86 )、住院治疗（比值比 = 0.79，95% CI = 0.64-0.99），以及在停药后 6 个月内完成阿片类药物处方（比值比 = 0.67，95% CI = 0.56-0.80）。所有队列中约有 5% 的患者经历过一次或多次药物治疗过量。结论 无论治疗持续时间长短，在停用丁丙诺啡后，急性护理服务使用和药物过量的风险都很高。尽管主要不良结果的发生率仍然很高，但随着治疗持续时间超过 15 个月，优越的结果变得显着。