PURPOSE Offi ce-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Effi cacy of this treatment in nonresearch clinical settings has not been studied. We examined the effi cacy and practicality of buprenorphine-naloxone treatment in primary care settings.
METHODSWe studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use.RESULTS Fifty-four percent of patients were sober at 6 months. There was no signifi cant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending selfhelp meetings.CONCLUSIONS Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources. Our fi ndings suggest that greater numbers of patients should have access to buprenorphinenaloxone treatment in nonspecialized settings.
In the context of an escalating opioid epidemic, infectious disease clinicians increasingly treat the infectious complications of injection drug use. In this learning unit, we review the history, pharmacology, and clinical use of buprenorphine as maintenance therapy for opioid use disorder, and we describe the process by which clinicians can obtain a buprenorphine waiver.
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