The SUMMIT Trial:

Pinto, Hayley; Maskrey, Vivienne; Swift, Louise; Rumball, Daphne; Wagle, Ajay; Holland, Richard

doi:10.1016/j.jsat.2010.07.009

Cited by 92 publications

(50 citation statements)

References 27 publications

(31 reference statements)

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“…Consistent with earlier research documenting decision processes regarding treatment for opioid dependence were our findings that prior experience with medications, fear of continued addiction or withdrawal (particularly with methadone), and desire to avoid methadone and its associated stigma all can play an important role in treatment decision-making (Gryczynski et al, 2013; Pinto et al, 2010). Personal experiences were central in decisions to seek buprenorphine treatment and negative views toward methadone and fear of methadone withdrawal strongly influenced preference for buprenorphine (Gryczynski et al, 2013), as did methadone-related stigma (Pinto et al, 2010). In our sample, attitudes towards both medications, among those who had experience with both, provided further evidence of the general favorability of buprenorphine over methadone.…”

Section: Discussionsupporting

confidence: 89%

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Yarborough

Stumbo

McCarty

et al. 2016

Drug and Alcohol Dependence

132

113

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Background Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients’ preferences and previous experiences influence treatment decisions. Understanding these issues may enhance treatment engagement and retention. Methods Adults with opioid dependence (n = 283) were recruited from two integrated health systems to participate in interviews focused on prior experiences with treatment for opioid dependence, knowledge of medication options, preferences for treatment, and experiences with treatment for chronic pain in the context of problems with opioids. Interviews were audio-recorded, transcribed verbatim, and coded using Atlas.ti. Results Our analysis revealed seven areas of consideration for opioid agonist treatment decision-making: 1) awareness of treatment options; 2) expectations and goals for duration of treatment and abstinence; 3) prior experience with buprenorphine or methadone; 4) need for accountability and structured support; 5) preference to avoid methadone clinics or associated stigma; 6) fear of continued addiction and perceived difficulty of withdrawal; and 7) pain control. Conclusion The availability of medication options increases the need for clear communication between clinicians and patients, for additional patient education about these medications, and for collaboration and patient influence over choices in treatment decision-making. Our results suggest that access to both methadone and buprenorphine will increase treatment options and patient choice and may enhance treatment adherence and outcomes.

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Section: Discussionsupporting

confidence: 89%

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Yarborough

Stumbo

McCarty

et al. 2016

Drug and Alcohol Dependence

132

113

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“…Although it is possible that the superior retention for methadone over buprenorphine in this trial reflects individuals not being randomized to their preferred treatment, given that opioid-dependent individuals often have strong preferences for one over the other (20), a study by Pinto and colleagues (21) suggests an alternative explanation. They conducted a practical trial in which 361 opioid- dependent individuals in the United Kingdom were allowed to select whether they would receive either buprenorphine or methadone maintenance treatment.…”

Section: Overview Of the Four Trials Showing No Benefit Of Adding Coumentioning

confidence: 97%

The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review

Carroll

Weiss

2017

AJP

179

123

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Objective Although counseling is a required part of office-based buprenorphine treatment of opioid use disorders, the nature of what constitutes appropriate counseling is unclear and controversial. We review the existing literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment. Method Review of randomized controlled studies testing the efficacy of adding a behavioral intervention to buprenorphine maintenance treatment. Results Four key studies showed no benefit from adding a behavioral intervention to buprenorphine plus medical management, while 4 studies indicated some benefit for specific behavioral interventions, primarily contingency management. We examine the findings from the negative trials in the context of six questions: 1) Is buprenorphine that effective? 2) Is medical management that effective? 3) Are behavioral interventions that ineffective in this population? 4) How has research design affected the results of studies of buprenorphine plus behavioral treatment? 5) What do we know about subgroups of patients who do and do not seem to benefit from behavioral interventions? 6) What should clinicians aim for in terms of treatment outcome in buprenorphine maintenance? Conclusions High-quality medical management may suffice for some patients, but there are few data regarding the types of individuals for whom medical management is sufficient. Physicians should consider a stepped care model in which patients may begin with relatively non-intensive treatment, with increased intensity for patients who struggle early in treatment. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment.

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“…The number of prescriptions for buprenorphine has increased steadily since its approval and office-based buprenorphine has been associated with bringing new users into treatment. Buprenorphine may appeal to patients who are unwilling or unable to access methadone treatment, particularly those residing in rural areas where access to methadone treatment may be limited (Apple et al, 2004; Becker and Fiellin, 2005; Cicero et al, 2005; Havens et al, 2007; Fiellin, 2007; Korthius et al, 2010; Pinto et al, 2010; Rosenblum et al, 2007; Schnoll, 2001; Schwartz et al, 2008; Sullivan et al, 2005; Winstock et al, 2009; Zacny et al, 2003). …”

Section: Introductionmentioning

confidence: 99%

The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A review

Dunn¹,

Sigmon²,

Strain³

et al. 2011

Drug and Alcohol Dependence

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Background The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes. Methods Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions using pre-taper maintenance as a cofactor. Results Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed. Conclusion The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes.

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The SUMMIT Trial:

Cited by 92 publications

References 27 publications

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review

The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A review

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