In-Patient Medication Order Trends of Methadone and Buprenorphine for Chronic Pain and Opioid Use Disorder: A Multi-Center 10-Year Analysis Between 2014 and 2023

Methadone and buprenorphine are commonly utilized to manage chronic pain and opioid use disorder (OUD), yet data on their prescribing trends remain limited. This multi-center retrospective study examines the use of methadone and buprenorphine in-patient medication orders across three University of California health systems over a 10-year period between the beginning of 2014 and the end of 2023. The analysis included 3,754 hospitalized patients with OUD and 4,990 hospitalized patients with chronic pain. Our study findings suggest that methadone may have been the primary treatment for chronic pain and OUD over the time frame, but buprenorphine use considerably increased over the latter portion of the decade for OUD, especially among younger patients and those with psychiatric comorbidities, reflecting national efforts to expand access. Laboratory findings may highlight the prevalence of comorbidities, particularly among methadone-treated patients. Methadone in-patient medication orders were estimated to have higher morphine equivalent daily doses (MEDDs) compared to buprenorphine. The decline in MEDDs and opioid prescribing for chronic pain over the study period align with broader public health initiatives aimed at reducing opioid-related harm and using non-opioid alternatives for analgesia. Prospective studies are needed to confirm the trends identified in this study.