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dc.contributor.authorGrande, Lucinda A
dc.contributor.authorCundiff, Dave
dc.contributor.authorGreenwald, Mark K
dc.contributor.authorMurray, MaryAnne
dc.contributor.authorWright, Tricia E
dc.contributor.authorMartin, Stephen A
dc.date.accessioned2023-09-29T21:02:14Z
dc.date.available2023-09-29T21:02:14Z
dc.date.issued2023-06-16
dc.identifier.citationGrande LA, Cundiff D, Greenwald MK, Murray M, Wright TE, Martin SA. Evidence on Buprenorphine Dose Limits: A Review. J Addict Med. 2023 Sep-Oct 01;17(5):509-516. doi: 10.1097/ADM.0000000000001189. Epub 2023 Jun 16. PMID: 37788601; PMCID: PMC10547105.en_US
dc.identifier.eissn1935-3227
dc.identifier.doi10.1097/ADM.0000000000001189en_US
dc.identifier.pmid37788601
dc.identifier.urihttp://hdl.handle.net/20.500.14038/52589
dc.description.abstractObjectives: As overdose deaths from fentanyl continue to increase, optimizing use of medications for opioid use disorder has become increasingly important. Buprenorphine is a highly effective medication for reducing the risk of overdose death, but only if a patient remains in treatment. Shared decision making between prescribers and patients is important to establish a dose that meets each patient's treatment needs. However, patients frequently face a dose limit of 16 or 24 mg/d based on dosing guidelines on the Food and Drug Administration's package label. Methods: This review discusses patient-centered goals and clinical criteria for determining dose adequacy, reviews the history of buprenorphine dose regulation in the United States, examines pharmacological and clinical research results with buprenorphine doses up to 32 mg/d, and evaluates whether diversion concerns justify maintaining a low buprenorphine dose limit. Results: Pharmacological and clinical research results consistently demonstrate buprenorphine's dose-dependent benefits up to at least 32 mg/d, including reductions in withdrawal symptoms, craving, opioid reward, and illicit use while improving retention in care. Diverted buprenorphine is most often used to treat withdrawal symptoms and reduce illicit opioid use when legal access to it is limited. Conclusions: In light of established research and profound harms from fentanyl, the Food and Drug Administration's current recommendations on target dose and dose limit are outdated and causing harm. An update to the buprenorphine package label with recommended dosing up to 32 mg/d and elimination of the 16 mg/d target dose would improve treatment effectiveness and save lives.en_US
dc.language.isoenen_US
dc.relation.ispartofJournal of Addiction Medicineen_US
dc.relation.urlhttps://doi.org/10.1097/adm.0000000000001189en_US
dc.rightsCopyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on be- half of the American Society of Addiction Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permis- sible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectbuprenorphineen_US
dc.subjectdose limiten_US
dc.subjectopioid use disorderen_US
dc.titleEvidence on Buprenorphine Dose Limits: A Reviewen_US
dc.typeJournal Articleen_US
dc.source.journaltitleJournal of addiction medicine
dc.source.countryNetherlands
dc.identifier.journalJournal of addiction medicine
refterms.dateFOA2023-09-29T21:02:15Z
dc.contributor.departmentCenter for Integrated Primary Careen_US
dc.contributor.departmentFamily Medicine and Community Healthen_US


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Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on be-
half of the American Society of Addiction Medicine. This is an open-access
article distributed under the terms of the Creative Commons Attribution-Non
Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permis-
sible to download and share the work provided it is properly cited. The work
cannot be changed in any way or used commercially without permission from
the journal.
Except where otherwise noted, this item's license is described as Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on be- half of the American Society of Addiction Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permis- sible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.