• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Starting Buprenorphine: Is Timing Everything?

Starting Buprenorphine: Is Timing Everything?

July 3, 2021
John O’Neal, MD
From The Carlat Addiction Treatment Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
John O’Neal, MD Dr. O’Neal has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Review of: Jakubowski A et al, J Subst Abuse Treat 2020;119:108140

Buprenorphine is a safe and effective treatment of opioid use disorder (OUD), but studies show that less than two-thirds of patients treated with buprenorphine are still in treatment 6 months later (Timko C et al, J Addict Dis 2016;35(1):22–35). Since the highest rate of dropout is during the first month of treatment, Jakubowski and colleagues decided to look at factors affecting dropout and hypothesized that the timing of the first dose of buprenorphine might be a decisive factor. The researchers speculated that patients receiving their first dose on their very first visit might be more likely to stay in treatment over time.

The investigators looked retrospectively at a cohort of 222 patients engaged in treatment in a federally qualified health center who were treated with buprenorphine. They divided them into two groups: those who were prescribed buprenorphine at the initial evaluation, and those who were prescribed buprenorphine later but within 30 days of the initial visit. Treatment consisted of buprenorphine prescription plus visits with a primary care physician every 1–2 weeks until stable, then monthly.

Of the 222 patients, 89 (40%) were prescribed buprenorphine at the initial visit, and 133 patients (60%) were prescribed buprenorphine later but within the first 30 days. Eighty percent of patients remained in treatment through the first 30 days. A higher percentage (85% vs 77%) of same-day prescription receipt patients remained in treatment through the first 30 days, but this increase was not statistically significant (p = 0.11). It was noted that alcohol or benzodiazepine use was associated with delayed prescription of buprenorphine, but the results were the same even when these factors were adjusted out.

CATR’s Take
This retrospective study did not identify a statistically significant improvement in treatment retention associated with initiating buprenorphine on the first day of evaluation when compared with later initiation. On the other hand, early treatment did not show any sign of increasing dropout, and it should be emphasized as it may decrease overdose risk and be associated with other unmeasured benefits.
Addiction Treatment
KEYWORDS buprenorphine dosage-timing opioid-use-disorder
    John O’Neal, MD

    More from this author
    www.thecarlatreport.com
    Issue Date: July 3, 2021
    SUBSCRIBE NOW
    Table Of Contents
    Does CBT Enhance Pharmacotherapy for Addiction?
    Starting Buprenorphine: Is Timing Everything?
    Cannabidiol for Crack-Cocaine Craving: Negative Findings
    Nicotine Patch for Cannabis Withdrawal?
    Breastfeeding and Addiction
    The Pregnant Patient With Substance Use Disorder
    Naloxone Prescribing
    A New High-Dose Naloxone: Life Saver or Punishment?
    CME Post-Test - Addiction in Pregnancy, CATR, July/August 2021
    DOWNLOAD NOW
    Featured Book
    • OUDFB1e_Cover_Binding.png

      Treating Opioid Use Disorder—A Fact Book (2024)

      All the tools you need to assess and treat patients struggling with opioid use disorder. 
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.