Prior Buprenorphine Experience Is Associated With Office-Based Buprenorphine Treatment Outcomes

Abstract

Objectives As buprenorphine treatment and illicit buprenorphine use increase, many patients seeking buprenorphine treatment will have had prior experience with buprenorphine. Little evidence is available to guide optimal treatment strategies for patients with prior buprenorphine experience. We examined whether prior buprenorphine experience was associated with treatment retention and opioid use. We also explored whether type of prior buprenorphine use (prescribed or illicit use) was associated with these treatment outcomes. Methods We analyzed interview and medical record data from a longitudinal cohort study of 87 individuals who initiated office-based buprenorphine treatment. We examined associations between prior buprenorphine experience and 6-month treatment retention using logistic regression models, and prior buprenorphine experience and any self-reported opioid use at 1, 3, and 6 months using non-linear mixed models. Results Most (57.4%) participants reported prior buprenorphine experience; of these, 40% used prescribed buprenorphine and 60% illicit buprenorphine only. Compared to buprenorphine-naïve participants, those with prior buprenorphine experience had better treatment retention (AOR=2.65, 95% CI=1.05–6.70). Similar associations that did not reach significance were found when exploring prescribed and illicit buprenorphine use. There was no difference in opioid use when comparing participants with prior buprenorphine experience to those who were buprenorphine-naive (AOR=1.33, 95% CI=0.38–4.65). Although not significant, qualitatively different results were found when exploring opioid use by type of prior buprenorphine use (prescribed buprenorphine vs. buprenorphine-naïve, AOR=2.20, 95% CI=0.58–8.26; illicit buprenorphine vs. buprenorphine-naïve, AOR=0.47, 95% CI=0.07–3.46). Conclusions Prior buprenorphine experience was common and associated with better retention. Understanding how prior buprenorphine experience affects treatment outcomes has important clinical and public health implications.

Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine

“…The covariate results from the multivariable analyses are consistent with previous literature: prior buprenorphine use, whether illicit or prescribed, was associated with decreased risk of disengagement (Alford et al, 2011; Cunningham et al, 2013). Similarly, female gender was found to be negatively associated with disengagement in both models; prior literature shows that female patients have improved treatment retention (Burns et al, 2015; Öhlin et al, 2015).…”

Long-term retention in Office Based Opioid Treatment with buprenorphine

“…(Fareed et al, 2014; Ferri, Finlayson, Wang, & Martin, 2014; Hser et al, 2014) Illicit buprenorphine use at OBOT enrollment is associated with increased short-term retention in buprenorphine treatment. (Alford et al, 2011; Cunningham, Roose, Starrels, Giovanniello, & Sohler, 2013) Once enrolled in OBOT, illicit benzodiazepine(Ferri et al, 2014) and illicit opioid (Fiellin et al, 2008; Stein, Patricia Cioe, & Friedmann, 2005) use early in treatment are both predictive of short-term disengagement. Cocaine use has also been associated with short-term disengagement (Gryczynski et al, 2014; Sullivan et al, 2010) although not consistently.…”

Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants

“…Existing data suggest that many illicit buprenorphine users take diverted buprenorphine to reduce symptoms of opioid withdrawal, not for intoxication or euphoria; thus, illicit buprenorphine use may in part be due to lack of access to BMT (Bazazi et al, 2011; Genberg et al, 2013; Gwin Mitchell et al, 2009; Lofwall & Havens, 2012; Monte et al, 2009; Sohler et al, 2013). Among BMT patients, prioir illicit buprenorphine use has not been associated with negative treatment outcomes (Cunningham et al, 2013), and clinical experience suggests that PWUD attempt to cut down or stop using opioids with illicit buprenorphine for a period of time before they actually initiate BMT. Therefore, illicit buprenorphine users who could benefit from BMT may be ready for treatment but experiencing barriers to care; however, additional data is necessary to confirm these clinical observations.…”