# The impact of chronic pain on buprenorphine treatment retention among patients with opioid use disorder.

> **NIH NIH R03** · DUKE UNIVERSITY · 2021 · $80,500

## Abstract

Abstract
A critical approach to reducing the national epidemic of opioid-related morbidity and mortality includes
maximizing retention rates of opioid agonist therapy (OAT) among individuals with OUD. In particular, OAT
using buprenorphine, compared to methadone, may be a suitable starting point for many patients with OUD
given its relatively broader safety profile (e.g., lower likelihood of overdose), and increased accessibility and
lower associated stigma given that it can be prescribed in office-based medical settings. Nevertheless, among
the fraction that do utilize buprenorphine, rates of long-term treatment retention, which are crucial to facilitating
best outcomes, are low. Thus, a better understanding of the barriers to sufficient buprenorphine treatment
retention are needed in order to inform efforts at optimizing current practice of an effective treatment. One
factor common among many patients with OUD that may negatively affect buprenorphine treatment retention is
the co-occurring presence of chronic non-cancer pain (CNCP). Current research shows that up to
approximately two-thirds of patients with OUD in medical settings, for whom buprenorphine treatment could be
applicable, have a co-occurring CNCP condition. However, despite the prevalence of CNCP among patients
with OUD, remarkably little is known about its impact on buprenorphine treatment retention. The present R03
proposal will address this gap in the literature through secondary analysis of a large electronic health record
database of patients receiving buprenorphine treatment for OUD. The overall goal of this application is to better
understand how CNCP may operate as a risk factor for lower buprenorphine retention, and in turn, how
buprenorphine treatment can be optimized to improve retention outcomes among patients with co-occurring
OUD and CNCP. Specifically, we will first determine the extent to which the impact of CNCP on treatment
retention depends on uncontrolled pain during treatment characterized via multi-level growth curve modeling.
To supplement these findings, we will conduct retrospective chart reviews to identify the extent to which
ongoing pain vs. other reasons were reported for premature treatment discontinuation. Reasons will also be
identified by empirically-defined buprenorphine adherence trajectory groups to indicate temporal specificity of
discontinuation reasons. Furthermore, we aim to elucidate the association between buprenorphine dose and
treatment retention among patients with co-occurring OUD and CNCP, which may represent a modifiable
factor that could be targeted to improve retention. Together, the findings from this research may inform
targeted efforts to enhance the clinical impact of an already existing treatment for OUD in the face of a rapidly
increasing opioid epidemic, which could ultimately lead to greater reductions in opioid-related morbidity and
mortality and costly healthcare utilization.

## Key facts

- **NIH application ID:** 10202541
- **Project number:** 5R03DA049095-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Li-Tzy Wu
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $80,500
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10202541

## Citation

> US National Institutes of Health, RePORTER application 10202541, The impact of chronic pain on buprenorphine treatment retention among patients with opioid use disorder. (5R03DA049095-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10202541. Licensed CC0.

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