Outcomes of Buprenorphine Maintenance in Office-Based Practice

Abstract

Buprenorphine is an efficacious treatment for opioid dependence recently approved for office-based medical practice. The purpose of the study was to describe the background characteristics, treatment process, outcomes and correlates of outcomes for patients receiving buprenorphine maintenance in "real world" office-based settings in New York City, without employing the many patient exclusion criteria characterizing clinical research studies of buprenorphine, including absence of co-occurring psychiatric and non-opioid substance use disorders. A convenience sample of six physicians completed anonymous chart abstraction forms for all patients who began buprenorphine induction or who transferred to these practices during 2003-2005 (N = 86). The endpoint was the patient's current status or status at discharge from the index practice, presented in an intent-to-treat analysis. The results were: male (74%); median age (38 yrs); White, non-Hispanic (82%); employed full-time, (58%); HCV+ (15%); substance use at intake: prescription opioids (50%), heroin (35%), non-opioids (49%); median length of treatment (8 months); median maintenance dose (15 mg/day); prescribed psychiatric medication (63%). The most frequent psychiatric disorders were: major depression, obsessive-compulsive and other anxiety, bipolar. At the endpoint: retained in the index practice (55%); transferred to other buprenorphine practice (6%); transferred to other treatment (7%); lost to contact or out of any treatment (32%). Outcomes were positive, in that 2/3 of patients remained in the index practice or transferred to other treatment. Patients living in their own home or misusing prescription opioids (rather than heroin) were more likely, and those employed part-time were less likely, to be retained in the index practice. At the endpoint, 24% of patients were misusing drugs or alcohol. Co-occurring psychiatric disorders and polysubstance abuse at intake were common, but received clinical attention, which may explain why their effect on outcomes was minimal.

Home Buprenorphine/Naloxone Induction in Primary Care

“…Higher (>12 mg) day 1 doses may well be safe and effective if withdrawal symptoms persist, given buprenorphine's µ opioid agonist ceiling and limited potential for CNS and respiratory depression. 25,26 Rates of treatment retention at 24 weeks (50%) were similar to those in diverse settings and to national practice trends, 5,22,27,28 and are noteworthy among a mostly heroin-using sample with 78% unemployment and high rates of criminal justice involvement. Self-reported opioid use declined markedly over 24 weeks.…”

Office-Based Management of Opioid Dependence with Buprenorphine: Clinical Practices and Barriers

“…1 Buprenorphine is a safe, effective medication for opioid dependence that is associated with increased treatment retention, reduced illicit opioid use, reduced opioid craving, increased survival, and few adverse effects in research and community office-based settings. [2][3][4][5][6][7][8][9][10][11][12] With the enactment of the Drug Addiction Treatment Act (DATA) of 2000 and the Food and Drug Administration's approval of sublingual buprenorphine for the treatment of opioid dependence in October 2002, office-based physicians in the United States, such as primary care physicians and psychiatrists, gained the opportunity to treat opioid-dependent patients with buprenorphine, commonly referred to as office-based opioid treatment (OBOT). 13 To provide OBOT with buprenorphine, DATA 2000 requires physicians to obtain a waiver from the federal Center for Substance Abuse Treatment (CSAT).…”

Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After Treatment

“…The dropout rate is substantial for those on buprenorphine maintenance, often leading to opioid relapse. 6 Also, the abuse of buprenorphine appears to be increasing. It is commonly diverted to relieve opioid withdrawal symptoms and to reduce the use of other opioids.…”