More Potent Opioids Require More Potent Treatment Options

Background: Overdose deaths in the United States have been rising, driven by synthetic opioids such as fentanyl. Fentanyl is estimated to be 50 to 100 times more potent than heroin, and is the dominant street opioid in many locations. Anecdotally, practitioners have observed that fentanyl users may experience withdrawal and drug craving at the usual Food and Drug Administration (FDA)-recommended fentanyl dose of 16 mg/day. Objective: To determine if higher buprenorphine doses result in increased retention in addiction treatment. Design: Retrospective cohort study. Participants/Methods: Patients initiating buprenorphine treatment for opioid use disorder (OUD) in Rhode Island between 2016 and 2020 at a dose of 16 or 24 mg sublingually formed the cohort. Primary outcome was treatment retention at 180 days. Results: 6499 patients formed the cohort. Most patients were aged 25 to 44 years (57%), male (61%), with private insurance (47%) or Medicaid (33%). Overall, 59% of patients in the 16- more...