buprenorphine (Transtec Pro / Transtec)

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

Dacha Phoebe P, Eglovitch Michelle M, Melmer Monica M, Martin Caitlin E CE et al.

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. 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. 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. 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.

County-level context and differential policy impacts on buprenorphine use among medicaid enrollees with opioid use disorder in Kentucky, 2018-2025.

Miracle Dustin K DK, Slavova Svetla S, Freeman Patricia R PR, Tarima Sergey S

To estimate changes in buprenorphine use among Kentucky Medicaid enrollees with opioid use disorder (OUD) after policy changes and pandemic disruptions, and whether impacts differed by county-level context, primarily rurality and, secondarily, opioid treatment program (OTP) availability. We analyzed Kentucky Medicaid claims from January 2018 through June 2025, identifying enrollees with diagnosed OUD to construct 10,800 county-month observations. Logistic regression fitted with weighted generalized estimating equations was used for statistical modeling of an interrupted time series (ITS) design to assess changes in the monthly proportion of enrollees with OUD receiving buprenorphine. Interruptions included removal of prior authorization (PA) requirements for transmucosal buprenorphine, methadone coverage initiation, COVID-19-related policy changes, and federal X-waiver elimination. Rurality and OTP availability were evaluated as effect modifiers. The proportion of enrollees with OUD receiving buprenorphine increased from 0.29 to 0.45 across the study period. PA removal was associated with an immediate increase in the odds of buprenorphine use (odds ratio [OR]=1.043; 95% confidence interval [CI]=1.025, 1.061), corresponding to a 1.4-percentage-point increase. X-waiver elimination was associated with a sustained increase in trend (OR 1.007; 95% CI 1.004-1.010). Differential effects by rurality were limited to the COVID-19 period. Counties without an OTP responded more strongly to PA removal than counties with an OTP (P = 0.037). Removal of administrative and regulatory barriers was associated with increased buprenorphine use among Kentucky Medicaid enrollees with OUD, with effects varying by county-level context, particularly OTP availability.

Optimizing Buprenorphine Induction: Updated Approaches in Opioid Use Disorder Management.

McGarrity Jonathan J, Canale Michelle M, Zhang Sarah Jingying SJ

Opioids and the oxytocin system: Mechanistic interactions altering maternal neuroplasticity.

Richardson Lauren M LM, Veenema Alexa H AH, Brummelte Susanne S

Due to the ongoing opioid epidemic, there has been a rise in the use of medications for opioid use disorder (MOUD) during pregnancy. This paper examines how buprenorphine (BUP), the new golden standard for MOUD, may disrupt maternal care through dysregulation of the oxytocin (OXT) system. OXT is central to parturition, lactation, caregiving, and coordinating activity across the maternal brain network (MBN), including the paraventricular (PVN) and supraoptic nucleus, medial preoptic area, and nucleus accumbens. The endogenous opioid system normally regulates OXT release, with μ-opioid receptor (μOR) and κ-opioid receptor (κOR) signaling influencing OXT neurons. BUP has a unique mechanism of action as it is a partial μOR agonist and a κOR antagonist, which may lead to complex interactions with endogenous opioids and subsequently the OXT system during pregnancy. In line with this, recent preclinical research suggests that BUP exposure during gestation results in reduced maternal motivation and inconsistent pup-directed care in rodent models. Therefore, this paper will explore the possible underlying mechanisms of how BUP exposure may dysregulate the OXT system and thus play a role in the observed maternal care deficits. In particular, we propose that chronic BUP exposure dampens PVN OXT output, disrupts synchrony across the MBN, and constrains OXT-driven neuroplasticity. Further, we will discuss the potential of postpartum OXT administration to restore maternal behaviors by re-engaging OXT signaling and network activity in both clinical and preclinical models. By integrating receptor, network, and behavioral evidence, this review provides a framework for understanding BUP's impact on maternal care through oxytocinergic disruptions and for potential translational interventions.