Home Buprenorphine/Naloxone Induction in Primary Care

Lee, Joshua D.; Grossman, Ellie; DiRocco, Danae; Gourevitch, Marc N.

doi:10.1007/s11606-008-0866-8

Cited by 105 publications

(119 citation statements)

References 24 publications

Supporting

Mentioning

109

Contrasting

Order By: Relevance

“…3,4 Primary care physicians see patients in the clinic and provide prescriptions, typically for a 30-day supply of buprenorphine (some patients in longstanding recovery are given prescriptions for up to 3 months of medication), which patients fill at community pharmacies, often at little or no charge (depending on their insurance required co-payment). The disaster led to the suspension of clinic services caring for all 132 active patients, along with a variety of citywide hospital, outpatient clinic, pharmacy, and transit closures.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

et al. 2014

Self Cite

View full text Add to dashboard Cite

In October 2012, Bellevue Hospital Center (Bellevue) in New York City was temporarily closed as a result of Hurricane Sandy, the largest hurricane in US history. Bellevue's primary care office-based buprenorphine program was temporarily closed and later relocated to an affiliate public hospital. Previous research indicates that the relationships between disaster exposure, substance use patterns, psychiatric symptoms, and mental health services utilization is complex, with often conflicting findings regarding post-event outcomes (on the individual and community level) and antecedent risk factors. In general, increased use of tobacco, alcohol, and illicit drugs is associated with both greater disaster exposure and the development or exacerbation of other psychiatric symptoms and need for treatment. To date, there is limited published information regarding post-disaster outcomes among patients enrolled in office-based buprenorphine treatment, as the treatment modality has only been relatively approved recently. Patients enrolled in the buprenorphine program at the time of the storm were surveyed for self-reported buprenorphine adherence and illicit substance and alcohol use, as well as disaster-related personal consequences and psychiatric sequelae poststorm. Baseline demographic characteristics and insurance status were available from the medical record. Analysis was descriptive (counts and proportions) and qualitative, coding open-ended responses for emergent themes. There were 132 patients enrolled in the program at the time of the storm; of those, 91 were contacted and 89 completed the survey. Almost half of respondents reported disruption of their buprenorphine supply. Unexpectedly, patients with psychiatric comorbidity were no more likely to report increased use/relapse as a result. Rather, major risk factors associated with increased use or relapse post-storm were: (1) shorter length of time in treatment, (2) exposure to storm losses such as buprenorphine supply disruption, (3) a pre-storm history of red flag behaviors (in particular, repeat opioid-positive urines), and (4) new-onset poststorm psychiatric symptoms. Our findings highlight the relative resilience of buprenorphine as an office-based treatment modality for patients encountering a disaster with associated unanticipated service disruption. In responding to future disasters, triaging patient contact and priority based on a history of red-flag behaviors, rather than a history of psychiatric comorbidity, will likely optimize resource allocation, especially among recently enrolled patients. Additionally, patients endorsing new-onset psychiatric manifestations following disasters may be an especially high-risk group for poor outcomes, warranting further study.

show abstract

Section: Introductionmentioning

confidence: 99%

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…Similar reductions in treatment-retention rates were observed in both treatment arms in this subgroup. The challenge of buprenorphine induction among patients transitioning from methadone has been previously reported, 12,13,22 and further studies are needed for elucidating treatment protocols regarding induction in patients transitioning from the use of long-acting opioids such as methadone.…”

Section: Discussionmentioning

confidence: 99%

“…The induction of therapy in patients dependent on long-acting opioids (eg, methadone) might be complicated by an increased risk for precipitated or prolonged withdrawal. [11][12][13] Limited clinical evidence exists regarding the efficacy of BNX film for induction in patients dependent on long-acting opioids, or among those transitioning from long-acting extended-release preparations. 14,15 Thus, buprenorphine monotherapy is the only treatment approved and recommended 11 for induction in patients transitioning from long-acting opioids.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Higher-bioavailability Buprenorphine/Naloxone Sublingual Tablet Versus Buprenorphine/Naloxone Film for the Treatment of Opioid Dependence During Induction and Stabilization: A Multicenter, Randomized Trial

Gunderson

Hjelmström

Sumner³

2015

Clinical Therapeutics

View full text Add to dashboard Cite

Based on the findings from this study in patients with opioid dependence, the higher-bioavailability BNX sublingual tablet formulation was noninferior to both generic buprenorphine (induction) and BNX film (stabilization). These findings suggest that BNX sublingual tablets are an efficacious and well-tolerated option for induction and early stabilization treatment of opioid dependence. ClinicalTrials.gov identifier: NCT01908842.

show abstract

“…Of the three phases of BN treatment, induction, the initiation of BN treatment, is a key to treatment success. In fact, a substantial proportion of BN treatment failures occur during the first 7 days of treatment [57][58][59] . One reason for limited BN treatment is the challenge patients and providers face with BN induction 60,61 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Outcome During a 6-Month Follow-Up Among Heroin Dependent Patients Receiving Buprenorphine/Naloxone Maintenance Treatment

Evren

Karabulut

Can

et al. 2014

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

View full text Add to dashboard Cite

Home Buprenorphine/Naloxone Induction in Primary Care

Abstract: Home buprenorphine induction was feasible and appeared safe. Induction complications occurred at expected rates and were not associated with short-term treatment drop-out.

Cited by 105 publications

References 24 publications

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

Effects of a Higher-bioavailability Buprenorphine/Naloxone Sublingual Tablet Versus Buprenorphine/Naloxone Film for the Treatment of Opioid Dependence During Induction and Stabilization: A Multicenter, Randomized Trial

Predictors of Outcome During a 6-Month Follow-Up Among Heroin Dependent Patients Receiving Buprenorphine/Naloxone Maintenance Treatment

Contact Info

Product

Resources

About