Assessing the impact of buprenorphine for opioid use disorder on infectious disease management

Introduction: Injection opioid misuse is associated with the transmission of infectious diseases (IDs) such as hepatitis B and C, and skin and soft tissue infections. Medications for opioid use disorder (MOUD) are effective treatments for opioid use disorder (OUD) and can reduce ID risk and improve outcomes. This study evaluated the association between treatment with buprenorphine extended-release (BUP-XR; SUBLOCADE®) or transmucosal buprenorphine (TM-BUP) and ID-specific incidence rates, all-cause healthcare resource utilization (HCRU), and ID-specific HCRU among patients treated for OUD continuously for ≥90 days. Methods: This retrospective cohort study assessed differences in outcomes between patients receiving BUP-XR vs. TM-BUP using the Veradigm® Network EHR electronic health records and linked claims dataset. The study period spanned from January 1, 2018 to June 30, 2024, with an index selection window from July 1, 2018 to December 31, 2023. The first qualifying buprenorphine treatment claim (either BUP-XR injection or TM-BUP prescription) during the selection window defined the index date. Descriptive analyses compared baseline characteristics of the BUP-XR and TM-BUP cohorts, while inverse probability of treatment weighting (IPTW) controlled for confounding. The analysis utilized generalized linear models with a difference-in-differences design to examine the primary outcomes. Results: A total of 467 patients met criteria for the BUP-XR cohort and 118,112 patients for the TM-BUP cohort. After applying IPTW, the weighted sample size was 437 in the BUP-XR cohort and 118,104 in the TM-BUP cohort. During the 6-month baseline period pre-index date, skin conditions and hepatitis B and C were the most common acute infections observed in both unweighted cohorts. The adjusted analyses demonstrated a statistically significant reduction of 62% in the incidence of bacteremia in the BUP-XR cohort during follow-up (95% CI: 26%–81%). Patients on BUP-XR consistently had lower overall HCRU compared to TM-BUP during follow-up, including 56% fewer inpatient visits (95% CI: 38%–69%), 22% fewer emergency department visits (95% CI: 6%–35%), 21% fewer all-cause outpatient visits (95% CI: 17%–24%), and 77% fewer outpatient visits for treating sexually transmitted infections (95% CI: 43.4%–90.5%). Conclusions: Patients on BUP-XR showed a reduction in the incidence of bacteremia and overall HCRU relative to those on TM-BUP.