title: Non-buprenorphine opioid utilization among patients using buprenorphine.
abstract: OBJECTIVE
  Buprenorphine is commonly used to treat opioid use disorder; however, non-buprenorphine prescription opioid use among these patients is not well defined. We sought to estimate the prevalence of non-buprenorphine opioid use among incident buprenorphine users and quantify levels of opioid use prior to, during and after the first treatment episode.
  
  
  METHODS
  We used QuintilesIMS anonymized, individual-level, all-payer pharmacy claims to identify incident users of buprenorphine between January 2010 and July 2012 from a large cohort of approximately 50 million patients filling two or more prescriptions for any opioid during any calendar year between 2006 and 2013 in 11 states of interest.
  
  
  METHODS
  Eleven states within the United States.
  
  
  METHODS
  Of the individuals who met our inclusion criteria (n = 38 096), 55% were female and half were aged between 29 and 54 years. Median length of the first treatment episode was 55 days [interquartile range (IQR) = 28-168 days].
  
  
  METHODS
  We calculated four measures of non-buprenorphine opioid use: (1) number of prescriptions, (2) quantity dispensed, (3) days of supply and (4) total morphine milligram equivalents (MME) before, during and after the first treatment episode. Our primary outcome was the MME per opioid day supplied during each time period.
  
  
  RESULTS
  Approximately two-fifths (43%) of buprenorphine recipients filled an opioid prescription during the treatment episode and two-thirds (67%) filled an opioid prescription following treatment. The mean total of MME per opioid day supplied 12 months prior to treatment declined from 57 mg/per day [95% confidence interval (CI) = 57, 58] to 54 mg/per day (95% CI = 54, 55) during the treatment episode, then remained constant at 55 mg/per day (95% CI = 54, 56) following the treatment episode.
  
  
  CONCLUSIONS
  The use of buprenorphine for the treatment of opioid use disorder has increased markedly in the United States. However, a substantial proportion of patients fill prescriptions for non-buprenorphine opioids during and following such treatment.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daubresse
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Brendan
authors.initials: B
authors.lastname: Saloner
authors.affiliation: School of Social Service Administration, University of Chicago, Chicago, IL, USA.
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pollack
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.|Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; care coordination; chronic pain; opioid analgesic; opioid use disorder; quality of care