Disparities in Buprenorphine Dosing for Opioid Use Disorder Treatment

A recent study involving 5,000 adults enrolled in Medicaid in Philadelphia has revealed that patients prescribed higher daily doses of buprenorphine for opioid use disorder are significantly more likely to remain in treatment. Specifically, those receiving doses between 17 to 24 milligrams averaged 190 days in care, compared to just 90 days for patients on doses of 8 milligrams or less. Buprenorphine is recognized as one of the most effective treatments for opioid use disorder, as it partially activates opioid receptors, helping to prevent withdrawal and cravings without inducing euphoria, thereby lowering overdose risks.

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The study also highlighted concerning racial disparities in buprenorphine dosing. Black patients were found to be less likely than their white counterparts to receive the higher doses that could enhance their treatment outcomes. In contrast, patients diagnosed with musculoskeletal conditions, such as osteoarthritis or rheumatoid arthritis, were more likely to be prescribed higher doses. This disparity raises critical questions about equitable access to effective treatment options for opioid use disorder.

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The opioid crisis in Philadelphia has been exacerbated by the increasing potency and unpredictability of the street opioid supply, particularly with the prevalence of synthetic opioids like fentanyl and animal tranquilizers such as xylazine. These developments suggest that standard buprenorphine doses may no longer suffice to stabilize withdrawal symptoms for many patients, emphasizing the need for tailored dosing strategies.

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In December 2024, the U.S. Food and Drug Administration (FDA) updated its recommendations regarding buprenorphine dosing. The agency removed the term "target dose" from the drug label, indicating that while doses above 24 milligrams have not been thoroughly investigated in clinical trials, they "may be appropriate for some patients." This shift reflects a growing recognition of the need for flexibility in dosing to meet individual patient needs.

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Critics have pointed out that the observed disparities in buprenorphine dosing underscore systemic issues within healthcare access and treatment equity. Community Behavioral Health, Philadelphia’s Medicaid behavioral health managed-care organization, has initiated educational efforts about buprenorphine at faith-based conferences and engaged with local prescribers to address barriers to treatment. However, understanding the root causes of these disparities remains essential for ensuring equitable treatment for all patients.

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Future research and interventions will focus on addressing the identified disparities in buprenorphine dosing. Understanding the factors contributing to unequal access will be crucial in developing strategies that ensure all patients, particularly marginalized groups, receive the appropriate care needed for effective recovery from opioid use disorder.

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• “Patients who are prescribed higher daily doses of the medication buprenorphine for opioid use disorder are significantly more likely to stay in treatment.” — Assistant Professor, University of Pennsylvania’s School of Nursing

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• “Understanding why these differences occur, and how to address them, is essential to equitable treatment.” — Assistant Professor, University of Pennsylvania’s School of Nursing

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