Abstract
BACKGROUND: This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist.
METHODS: Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after the adoption of buprenophine/naloxone by a primary care practice in Rhode Island. Practice policy precluded patient discharges due to continuing drug use.
RESULTS: Patients (n=41) had a mean duration of opioid use of 15.7 years and most had a history of heroin use (63.4%). Thirty-nine percent of patients transferred from methadone maintenance. At 24 weeks, 59% remained in treatment. Nearly half of dropouts occurred in the first 30 days. Participants with opiate-positive toxicologies at week 1 were more likely to drop out of the program (P<.01) and had a significantly shorter retention time (P<.01) on average. Among other drug use and drug treatment variables, employment and addiction counseling during treatment were significantly associated with treatment retention (P=.03).
CONCLUSION: Retention rates in a real world, primary care-based buprenorphine maintenance practice reflect those reported in clinical trials. Abstinence during the first week of treatment and receipt of counseling were critical to patient retention.
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References
Hulse G, English D, Milne E, Holman C. The quantification of mortality resulting from the regular use of illicit opiates. Addiction. 1999;94:221–9.
Mark TL, Woody GE, Juday T, Kleber HD. The economic costs of heroin addiction in the United States. Drug Alc Depend. 2001;61:195–206.
Ward J, Mattick RP, Hall W. Methadone Maintenance Treatment and Other Opioid Replacement Therapies. London: Harwood Press; 1998.
O’Connor PG, Fiellin DA. Pharmacologic treatment of heroin-dependent patients. Ann Int Med. 2000;133:40–54.
Fiellin DA, Barthwell AG. Center for substance abuse treatment. Guideline development for office-based pharmacotherapies for opioid dependence. J Addict Dis. 2003;22:109–20.
Kosten TR, Fiellin DA. Buprenorphine for office-based practice: consensus conference overview. Am J Addiction. 2004;13:S1–7.
National Institute on Alcohol Abuse and Alcoholism. Physicians’ Guide To Helping Patients With Alcohol Problems. Bethesda, MD: NIH Publication; 1995;35:3769.
Peachey JE, Lei H. Assessment of opioid dependence with naloxone. Br J Addiction. 1988;83:193–201.
Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004.
Mattick RP, Ali R, White J, O’Brien S, Wolk S, Danz C. Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction. 2003;98:441–52.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Buprenorphine versus methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology. 1994;116:401–6.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psychol. 1994;151:1025–30.
Fischer G, Gombas W, Eder H, Jagsch R, Peternell A, Stuhlinger G. Buprenorphine versus methadone maintenance for the treatment of opioid dependence. Addiction. 1999;94:1337–47.
Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stizer ML, Bigelow GE. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med. 2000;343:1290–7.
Petitjean S, Stohler R, Deglon JJ, Livoti S, Waldvogel D, Uehlinger C. Double-blind randomized trial of buprenorphine and methadone in opiate dependence. Drug Alc Depend. 2001;62:97–104.
Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. 2003. The Cochrane Database of Systematic Reviews. The Cochrane Library Issue 4. www.cochranelibrary.com.
Hser YI, Hoffman V, Grella CE, Anglin MD. A 33-year follow-up of narcotic addicts. Arch Gen Psychol. 2001;58:503–508.
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Dr. Stein is a recipient of a National Institute on Drug Abuse Mid-Career Award
The authors have no conflicts of interest to declare for this article or this research.
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Stein, M.D., Cioe, P. & Friedmann, P.D. Brief report: Buprenorphine retention in primary care. J GEN INTERN MED 20, 1038–1041 (2005). https://doi.org/10.1111/j.1525-1497.2005.0228.x
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DOI: https://doi.org/10.1111/j.1525-1497.2005.0228.x