Characterizing Buprenorphine Dosing Frequency During Outpatient Medication Treatment For Opioid Use Disorder

Background: Sublingual buprenorphine for opioid use disorder (OUD) is indicated as a once-daily medication during stabilization and long-term treatment, yet patients may engage in “split dosing,” dividing the daily dose into multiple administrations. Methods: This secondary analysis examined buprenorphine dosing patterns among 165 stable non-pregnant outpatients with OUD and assessed concordance between patient-reported dosing and provider documentation. Results: Patients had been taking buprenorphine for a median of 16 months (range 1-78). Most patients reported 2- (n = 63, 38.2%) or 3-times- (n = 74, 44.8%) daily dosing. A Cohen’s kappa analysis revealed substantial agreement (κ = 0.604, P < .001) between patient self-report and clinical documentation. Patient-reported buprenorphine total daily doses were higher and chronic pain comorbidities more common among patients splitting their dose than once-daily dosing patients. Conclusions: These results characterize sublingual buprenorphine dosing frequencies among outpatients with OUD and highlight real-world divergence from Food and Drug Administration labeling among patients stabilized on buprenorphine, indicating the need for evidence-based, patient-centered dosing strategies in OUD treatment.