J Subst Use Addict Treat. 2026 Apr 28:209986. doi: 10.1016/j.josat.2026.209986. Online ahead of print.

ABSTRACT

INTRODUCTION: Higher buprenorphine maintenance doses (>24 mg daily) may be more effective in improving opioid use disorder (OUD) treatment outcomes in the era of fentanyl predominance. Evidence on maintenance dose trends remains limited, especially among vulnerable populations, who are disproportionately affected by opioid overdose deaths. The objective of this study was to describe trends in maintenance dose of buprenorphine for OUD and the association of social vulnerability with maintenance dose.

METHODS: We identified buprenorphine treatment episodes initiated between January 2019 and June 2021 using the IQVIA Longitudinal Prescription database. Episodes were assigned to a maintenance dose category of <16, 16-24, or >24 mg, to reflect dosages lower than, consistent with, or higher than the guideline-recommended target dose range, respectively. County-level social vulnerability was measured with the Minority Health Index (MHI). We used multinomial logistic regression with generalized estimating equations to test the association between MHI (stratified into quartiles) and maintenance doses <16 mg and >24 mg (with 16-24 mg as the reference group), adjusting for patient, geographic, and time characteristics.

RESULTS: Of 1,044,460 treatment episodes among 543,326 individuals (mean [SD] age 41.9 [12.6] years, 43% female), the most common buprenorphine maintenance dose category was 16-24 mg (62.7%), followed by <16 mg (34.5%), then >24 mg (2.8%). The median (IQR) episode duration was 64 (109) days. The proportion of episodes in the <16 mg category increased from 34.1% in 2019 to 39.2% in 2021, whereas prevalence of the remaining categories decreased. A greater proportion of episodes in the >24 mg category were in rural versus urban counties; the magnitude of this difference increased over time. Relative to 16-24 mg, maintenance dose >24 mg was more likely among individuals in the most vulnerable MHI quartile compared to the least vulnerable quartile (aOR 1.28, 95% CI 1.19-1.38).

CONCLUSION: During a period of growing evidence supporting higher buprenorphine maintenance doses, the prevalence of treatment episodes with maintenance dose <16 mg increased. Individuals in the highest social vulnerability quartile tended to receive higher doses, suggesting that some higher-risk groups may receive more intensive treatment, even as important gaps remain. These results can inform efforts targeting equitable, high-quality buprenorphine prescribing.

PMID:42061723 | DOI:10.1016/j.josat.2026.209986

J Subst Use Addict Treat. 2026 Apr 24:209998. doi: 10.1016/j.josat.2026.209998. Online ahead of print.

ABSTRACT

Despite comprising one-fifth of the population, individuals living in rural areas are underrepresented in clinical trials on substance use disorders (SUD). The inclusion of rural residents is critical to reducing disparities in health outcomes and improving adoption of evidence-based interventions for SUDs. The current commentary provides five guiding principles to assist researchers in including rural populations in trials. These principles emphasize including rural communities in the study design phase and throughout the research process, understanding the local rural context, consideration of operationalization of rural in research, suggested adaptions for research, and embracing opportunities for bi-directional and sustainable partnerships. When approached thoughtfully, research funding can catalyze rural capacity, foster durable partnerships, and enrich scientific inference to assist in establishing the evidence-base for SUD research.

PMID:42035881 | DOI:10.1016/j.josat.2026.209998

JAMA Intern Med. 2026 Apr 20. doi: 10.1001/jamainternmed.2026.0428. Online ahead of print.

NO ABSTRACT

PMID:42008248 | DOI:10.1001/jamainternmed.2026.0428