Two-year Experience with Buprenorphine-naloxone (Suboxone) for Maintenance Treatment of Opioid Dependence Within a Private Practice Setting

Abstract

Office-based buprenorphine-naloxone (Suboxone) treatment in the United States has significantly improved access to safe and effective opioid-dependence therapy. Little data from physicians' experiences prescribing Suboxone in private offices have been available. This retrospective chart review describes a family practitioner's first 2 years of clinical experience prescribing Suboxone for opioid dependence to 71 patients in a private office. After directly observed rapid office dose induction, Suboxone prescriptions were given monthly after evidence of continued stability. Urine was screened regularly and patients were referred for counseling and other ancillary services. Patients averaged 32 years old, 4.3 years of opioid dependence, and were primarily white (93%) and employed (70%). Fifty-two percent used heroin primarily (most by injection), and 70% had no agonist substitution therapy history. Almost half (47%) paid for their own treatment. Compliance during dose induction was excellent. Suboxone maintenance doses averaged 10 (range, 2-24) mg per day. More than 80% of urine samples were opioid-negative after Suboxone treatment began, although urinalysis did not always include a test for oxycodone. Seventy-five percent had successful outcomes by remaining in Suboxone treatment (43%), tapering successfully (21%), transferring to methadone maintenance (7%), or inpatient treatment (4%). Fifty-eight percent reported receiving counseling. Almost all (85%) paid their fees on time. There were no safety, medication abuse, or diversion issues detected. Overall, office-based Suboxone therapy was easily implemented and the physician considered the experience excellent. Suboxone maintenance was associated with good treatment retention and significantly reduced opioid use, and it is helping to reach patients, including injection drug users, without histories of agonist substitution therapy.

Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

“…Notably, in that study of persons leaving residential care, first appointment follow-up rates for continuing care in the first 10 days post-discharge were also low. Six-month retention in XR-NTX treatment here was very low (18%), lower than retention rates reported with buprenorphine maintenance (Cunningham, et al, 2008; Finch, Kamien, & Amass, 2007; Gryczynski, et al, 2014; Mattick, Breen, Kimber, & Davoli, 2014; Soeffing, Martin, Fingerhood, Jasinski, & Rastegar, 2009) that is typically begun in the outpatient setting and therefore does not require linkage between treatment providers.…”

Home Buprenorphine/Naloxone Induction in Primary Care

“…22 It is higher than the 6% day 1-3 drop-out rate among self-pay patients in a North Carolina private practice setting, and lower than the 41% (29 of 70) of patients eligible for buprenorphine who never completed an initial assessment or did not return for observed induction at a Bronx, NY, community health center. 23,24 Clearly some attrition can be expected as patients plan for and then begin buprenorphine treatment. If home induction results in higher immediate drop-out or more induction complications, this would offset any resource-sparing advantages gained by combining the initial assessment and induction prescription into a single visit.…”

Preference for buprenorphine/naloxone and buprenorphine among patients receiving buprenorphine maintenance therapy in France: A prospective, multicenter study

“…High levels of satisfaction with buprenorphine/naloxone have been reported elsewhere in short-term (12 weeks) and long-term (2-5 years) studies (Barry et al, 2007;Fiellin et al, 2008;Finch, Kamien, & Amass, 2007). Furthermore, treatment compliance with buprenorphine/naloxone, as with other opioid dependence treatments, has been associated with improved rates of opioid abstinence (Fiellin et al, 2006).…”