# Predictors and Processes of Early Buprenorphine Discontinuation

> **NIH VA I01** · PORTLAND VA MEDICAL CENTER · 2024 · —

## Abstract

Background: Buprenorphine and other medications for opioid use disorder (MOUD) are recommended as
standard of care in the treatment of opioid use disorder (OUD) and associated with positive health and
addiction-related outcomes.31,32 Although observational research suggests that buprenorphine treatment
greater than 12 months yields the greatest benefits,19,34,39 more than 50% of patients discontinue early.40,41
Patients who discontinue face substantially heightened risk of all-cause hospitalization, emergency department
visits, opioid overdose and death relative to those who continue treatment,32-34 and most will return to
substance use.14
Significance: What explains this high rate of discontinuation has not been well studied.20,21 Prior research,
largely utilizing retrospective administrative data, has identified some predictors, including polysubstance use,
younger age, minoritized race-ethnicity, male birth sex, higher pain interference and low buprenorphine
dose,4,10-11,25 but why or how such factors are linked with early discontinuation remains unknown. Research
probing the patient perspective is limited, drawing upon patients in clinical trials or small, homogenous
samples. The role of provider or system-level factors in discontinuation remains largely unexplored.
Innovation & Impact: Design and methodological innovations of the proposed study include: the national
scope of the sample; oversampling rural Veterans, women and Veterans of minoritized race and ethnicity in
surveys and interviews, and triangulating patient and provider interviews and survey data to understand areas
of convergence and divergence in perceptions regarding discontinuation decisions and treatment encounters.
The overall impact of this study is high because it will collect novel data that will identify modifiable factors that
inhibit patient retention in treatment, which can be used to develop interventions to improve retention, reduce
risk of relapse and improve the overall health and well-being of Veterans with OUD.
Specific Aims:
Aim 1. Surveys with a national sample of (N=965) Veterans prescribed buprenorphine for OUD paired with
administrative data and medical record review will identify modifiable patient-, provider- and system-level
factors predictive of buprenorphine discontinuation within 12-months of initiation.
Aim 2. Interviews with a national sample of patients (N=40) who recently discontinued buprenorphine and their
buprenorphine care provider (N=40) will investigate motivations for discontinuation and perspectives on the
process.
Methodology: We propose a prospective cohort study utilizing a convergent parallel mixed-methods design to
obtain complementary quantitative survey and qualitative interview data. We will enroll a national sample of
N=965 Veterans initiating buprenorphine, stratifying sampling to ensure diversity in terms of race, ethnicity,
birth sex and rural versus urban residence of patients enrolled. Longitudinal quantitative surveys at ba...

## Key facts

- **NIH application ID:** 10751426
- **Project number:** 1I01HX003745-01A1
- **Recipient organization:** PORTLAND VA MEDICAL CENTER
- **Principal Investigator:** Jessica Jasmine Wyse
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-10-01 → 2028-03-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10751426

## Citation

> US National Institutes of Health, RePORTER application 10751426, Predictors and Processes of Early Buprenorphine Discontinuation (1I01HX003745-01A1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10751426. Licensed CC0.

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