# Impact of initial buprenorphine prescribing strategies on retention in care for patients with opioid use disorder

> **NIH NIH K08** · BOSTON MEDICAL CENTER · 2024 · $187,823

## Abstract

PROJECT SUMMARY / ABSTRACT
Opioid overdose continues to take lives at an astounding rate, reaching a record high of 69,710 deaths in
2020. Medications for OUD such as buprenorphine reduce risk of opioid overdose mortality. While policy
efforts have expanded buprenorphine treatment capacity, buprenorphine remains underutilized due to poor
retention in care. Observational data from real-world settings demonstrate 180-day retention rates as low as
25-40%. Thus, the federal Overdose Prevention Strategy identifies research to improve retention as a key
priority. To this end, research examining buprenorphine dosage regimens could identify strategies to improve
retention. Data from trials and observational studies suggest that higher induction and maintenance dosage
could improve retention. Scarce literature describes current buprenorphine dosage practices, but the data we
do have suggest variable dosage practices, with many patients never achieving recommended dosage targets.
Furthermore, research has demonstrated downward trends in buprenorphine dosage levels, meaning that
underdosage may be growing. In this Mentored Research Career Development Award application, I propose to
examine the relationship between buprenorphine dosage regimens and OUD treatment retention. Specifically,
the goals of this work are to 1) describe current buprenorphine dosage practices in terms of dosage
trajectories, 2) estimate the impact of two distinct buprenorphine dosage strategies on retention, and 3)
estimate the population-level clinical and cost impact of improved buprenorphine dosage practices on retention
and overdose for the state of Massachusetts. In parallel, I have identified three training objectives: 1) develop
skills using machine learning clustering methods, 2) learn causal inference using a target trial emulation, and
3) develop simulation modeling skills. Through these training objectives, I will develop comprehensive
synergistic skills in the data sciences. The research in this proposal builds directly on my prior work using
pharmacy claims data to examine trends in buprenorphine receipt. This proposal leverages this prior
experience to investigate the role of specific buprenorphine dosage strategies on retention. I have identified a
supportive research environment and an experienced mentor team with a) content and methodologic expertise
and b) extensive track records in guiding trainees to independent research careers. The strength of these
resources will ensure that I gain the expertise necessary to succeed in completing the proposed scope of work
and achieve my long-term goal of becoming an independent physician investigator using large data to study
innovations for substance use disorder treatment. At the end of this award, I will be well-positioned to apply for
an R-level award using national Medicaid data to examine a) the impact of emerging buprenorphine dosage
strategies on retention as fentanyl adulteration penetrates the opioid supply, and b) di...

## Key facts

- **NIH application ID:** 10839392
- **Project number:** 5K08DA058052-02
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Alyssa Tilhou
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $187,823
- **Award type:** 5
- **Project period:** 2023-05-15 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10839392

## Citation

> US National Institutes of Health, RePORTER application 10839392, Impact of initial buprenorphine prescribing strategies on retention in care for patients with opioid use disorder (5K08DA058052-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10839392. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*