Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy

Abstract

Background Buprenorphine/naloxone was approved by the FDA for office-based opioid maintenance therapy (OMT), with little long-term follow-up data from actual office-based practice. 18-Month outcome data on the office-based use of buprenorphine/naloxone (bup/nx) and the impact of socioeconomic status and other patient characteristics on the duration and clinical effects of bup/nx are reported. Methods This retrospective chart review and cross-sectional telephone interview provide treatment retention of opioid-dependent patients receiving bup/nx-OMT in an office-based setting. 176 opioid-dependent patients from two different socioeconomic groups (high and low SES) were begun on bup/nx, started intensive outpatient treatment, and followed-up after a minimum of 18 months (18–42 months) by telephone interview to assess treatment outcome. Results 110 subjects (67%) completed the interview, 77% remained on bup/nx with no difference in retention between high and low SES groups. Those on bup/nx at follow-up were more likely to report abstinence, to be affiliated with 12-step recovery, to be employed and to have improved functional status. Conclusions: Bup/nx-OMT is a viable treatment option and when coupled with a required abstinence oriented addiction counseling program is effective in promoting abstinence, self-help group attendance, occupational stability, and improved psychosocial outcomes in both low SES and high SES patient populations over an 18–42-month period.

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

“…These beliefs are centered on a misguided understanding, which assumes that if a patient stops taking the opioid, then they are cured; however, this is not supported by the available evidence concerning detoxification and abstinence based treatment [13][14][15][16]. Additionally, buprenorphine/naloxone maintenance therapy has been shown to reduce rates of relapse, increase retention in treatment [17], and engage patients in psychosocial recovery models [18].…”

“…Assessing patients' symptomatology prior to and after initiation of medication assisted therapy, demonstrates how effective appropriately administered medications can be at supporting a patient's remission. The potential benefits of utilizing medications in patients with OUD include: assisting the patient in achieving remission from the disease, allowing the individual to engage in active recovery [18], and increasing retention in treatment A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:…”

“…Appropriate use of the medication within the rubric of effective psychosocial treatment, which must begin with a clear diagnosis of psychiatric co-morbidities, is the only acceptable and comprehensive approach to patient management that will improve outcomes. For any individual patient, this would likely include enhanced compliance with treatment plans and active engagement in the long-term recovery process [31,18,32].…”

Cost-Effectiveness of Long-Term Outpatient Buprenorphine-Naloxone Treatment for Opioid Dependence in Primary Care

“…Results may not be generalizeable to other office-based setting or populations that were not previously involved in a clinical trial, although other observational studies have demonstrated similar levels of stability for selected patients receiving bup/nx in primary care. 27,28,47,48 Costs and outcomes may not reflect current less-intensive patterns of care for clinically stable patients on bup/nx. Relapse to drug use after leaving office-based bup/nx treatment has not been documented, and drug use while in treatment was only 6% in this population; results were consistent when we varied these proportions in sensitivity analyses.…”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…Other studies have focused on meaningful comparisons regarding treatment modalities, efficacy methadone vs. bup/nal, and determination of risk factors for compliance and treatment success. Many of these studies have used short follow-up periods, and researchers have focused largely on retention rates, chart reviews, instances of buprenorphine administration, interviews, self-report of heroin use and criminal activity, and telephone or internet communication, to measure adherence and abstinence (Fareed et al, 2014;Maas, Barton, Maskrey, Pinto, & Holland, 2013;Mattick et al, 2014;Moore et al, 2016;Parran et al, 2010;Tkacz, Severt, Cacciola, & Ruetsch, 2012).…”