Larger dose of existing medication eyed as response to fentanyl
Gabrielle M. Etzel
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Increasing the dose of an opioid use disorder medication may strengthen the likelihood of abuse recovery for fentanyl users, according to a study published Monday and funded by the National Institutes of Health that may shift the tide in opioid epidemic policy.
“Effective treatment can save lives, but our proven treatments for opioid use disorders must evolve to match the challenges posed by the fentanyl crisis,” said Nora Volkow, the director of the National Institute on Drug Abuse.
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The oral medication buprenorphine at 16 milligrams was initially approved by the Food and Drug Administration in 2002. Other versions of the product, including injections, have been approved subsequently.
Buprenorphine diminishes the withdrawal symptoms of opioid dependency but has weaker effects than similar products, such as methadone, according to the Substance Abuse and Mental Health Services Administration.
The NIDA study, however, found that a higher dose of 24 mg is not only safe but is also more effective in aiding addiction recovery. People on the 24 mg dose of buprenorphine were 20% more likely to stay on treatment than those on the 16 mg dose.
“The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl,” said Rachel Wightman of Brown University, one of the principal investigators on the study. “Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose, up to 24 mg, may help improve treatment retention for these individuals.”
NIDA estimated that 70,601 people died due to synthetic opioid overdose in the U.S. in 2021. An article published in the New England Journal of Medicine in July estimated that opioid overdoses increased by nearly 282% between 2016 and 2021, with a significant portion of this increase during the early stages of the coronavirus pandemic.
“If science continues to demonstrate that a higher dosage of buprenorphine increases treatment retention, we must reevaluate clinical guidelines to optimize treatment and help people achieve recovery,” Volkow said.
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Researchers plan to conduct randomized clinical trials to better assess the daily consequences of a higher dose of buprenorphine as well as investigate the role of other factors that contribute to treatment retention, such as clinician prescribing practices and lifestyle.
“We have a responsibility to set patients up for success,” Wightman said.