Counseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence

Fiellin, David A.; Pantalon, Michael V.; Chawarski, Marek C.; Moore, Brent A.; Sullivan, Lynn E.; O’Connor, Patrick G.; Schottenfeld, Richard S.

doi:10.1056/nejmoa055255

Cited by 314 publications

(289 citation statements)

References 27 publications

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“…21 The findings of significant superiority of buprenorphine compared to naltrexone for retention and time to resuming heroin use are unique. The results for buprenorphine treated patients in this study regarding retention and maximum duration of opioid abstinence are similar to previous studies of buprenorphine, 19 and the results for naltrexone treated patients were comparable to the results of many studies, 24,33,34 suggesting that the findings regarding the greater efficacy of buprenorphine compared to naltrexone or placebo may generalize to other populations and settings.…”

Section: Discussionsupporting

confidence: 88%

“…Post-hoc comparisons indicated that buprenorphine-treated patients achieved longer maximum consecutive days of opiate abstinence compared to placebo-treated patients (p<0.01); the differences between buprenorphine and naltrexone (p=0. 19) and between naltrexone and placebo (p=0.18) were not significant.…”

Section: Heroin Use and Abstinencementioning

confidence: 81%

“…Manual-guided individual drug counseling was provided by nurses and used a treatment manual adapted from the enhanced counseling provided to buprenorphine maintained patients in an earlier study conducted in a primary care clinic in the US. 19 The nurses had no experience treating addictions prior to receiving 4 days of didactic training and then treating, under close supervision, at least 3 training cases during the pilot phase of the study. Individual counseling sessions lasted approximately 45 minutes; reviewed recent drug use or efforts at abstinence, urine test results, and self-help group attendance; and provided support and advice about preventing relapse.…”

Section: Drug Counselingmentioning

confidence: 99%

“…3,[14][15][16] Studies directly comparing buprenorphine and methadone report comparable or greater efficacy of methadone. 15,17 Advantages of buprenorphine, including decreased overdose risk, possibly lower abuse liability (especially when provided in a tablet formulation containing naloxone), and potential for three times per week dosing, 18,19 facilitated its introduction in Malaysia when methadone was still prohibited. No studies have directly compared the efficacy of opioid agonist treatment (with either buprenorphine or methadone) and naltrexone maintenance treatment.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial

Schottenfeld

Mazlan²

2008

The Lancet

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Background-Expanding access to effective treatments for heroin dependence is a global health priority that will also reduce HIV transmission. This study compares the efficacy for maintaining heroin abstinence, preventing relapse, and reducing HIV risk behaviors of three common treatments: detoxification followed by drug counseling only or drug counseling combined with opioid antagonist (naltrexone) or agonist (buprenorphine) maintenance treatment.

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Section: Discussionsupporting

confidence: 88%

Section: Heroin Use and Abstinencementioning

confidence: 81%

Section: Drug Counselingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial

Schottenfeld

Mazlan²

2008

The Lancet

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“…A key difference between this program and more traditional integrated programs was the ability to provide buprenorphine/naloxone (BPN/NLX, also known by the brand name suboxone), an opioid agonist treatment which has been shown to be effective for improving substance use outcomes in primary care settings. 52 In this qualitative study, using focus group and satisfaction survey data collected throughout the course of the program, we identify how patients view an integrated model of care, evaluate the key elements to its success and provide recommendations for other programs.…”

mentioning

confidence: 99%

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Drainoni

Farrell²,

Sorensen-Alawad³

et al. 2014

AIDS Patient Care and STDs

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The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs.

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Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence

Weiss

Potter

Fiellin

et al. 2011

Arch Gen Psychiatry

481

455

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Context No randomized trials have examined treatments for prescription opioid dependence, despite its increasing prevalence. Objective To evaluate the efficacy of brief and extended buprenorphine-naloxone treatment, with different counseling intensities, for patients dependent upon prescription opioids. Setting, Participants 653 treatment-seeking outpatients dependent on prescription opioids, at 10 U.S. sites from June 2006-July 2009. Design Multi-site, randomized clinical trial, using a two-phase adaptive treatment research design. Brief treatment (Phase 1) included 2-week buprenorphine-naloxone stabilization, 2-week taper, and 8-week post-medication follow-up. Patients with successful opioid use outcomes exited the study; unsuccessful patients entered Phase 2: extended (12-week) buprenorphine-naloxone treatment, 4-week taper, and 8-week post-medication follow-up. Main outcome measures Pre-defined “successful outcome” in each phase: composite measures indicating minimal or no opioid use, based on urine-confirmed self-reports. Interventions In both phases, patients were randomized to Standard Medical Management (SMM) or SMM+Opioid Drug Counseling (ODC); all received buprenorphine-naloxone. Results During Phase 1, only 6.6% (43/653) of patients had successful outcomes, with no difference between the SMM and SMM+ODC. In contrast, 49.2% (177/360) attained successful outcomes in Phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (Phase 2, week 24) dropped sharply to 8.6% (31/360), again with no counseling difference. In secondary analyses, successful Phase 2 outcomes were far more common while taking buprenorphine-naloxone than 8 weeks post-taper (49.2% (177/360) vs. 8.6% (31/360), p<0.001). Chronic pain did not affect opioid use outcomes; a history of ever using heroin was associated with lower Phase 2 success rates while taking buprenorphine-naloxone. Conclusions Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off buprenorphine-naloxone, even after 12 weeks of treatment, the likelihood of unsuccessful outcome is extremely high, even among patients receiving counseling in addition to medical management. Trial Registration ClinicalTrials.gov number NCT00316277

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Counseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence

Cited by 314 publications

References 27 publications

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence

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