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The practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment?

https://doi.org/10.1016/j.drugalcdep.2004.12.008Get rights and content

Abstract

Office-based buprenorphine holds the promise of bringing patients who have never received pharmacotherapy into treatment. In a cross-sectional and longitudinal analysis, we compared patients entering a clinical trial of buprenorphine in a Primary Care Clinic (PCC) and those entering a local Opioid Treatment Program (OTP) and we compared the clinical characteristics and treatment outcomes of PCC patients with no history of methadone treatment (new-to-treatment) to those with prior methadone treatment. PCC subjects (N = 96) were enrolled in a 26-week randomized clinical trial of office-based buprenorphine/naloxone provided in a PCC. OTP subjects (N = 94) were enrolled in methadone maintenance during the same time period. PCC subjects compared with OTP subjects were more likely to be male (77% versus 55%, p < 0.01), full-time employed (46% versus 15%, p < 0.001), have no history of methadone treatment (46% versus 61%, p < 0.05), have fewer years of opioid dependence (10 versus 15, p < 0.001), and lower rates of injection drug use (IDU) (44% versus 60%, p = 0.03). The new-to-treatment PCC subjects were younger (36 years versus 41 years, p = 0.001), more likely to be white (77% versus 57%, p = 0.04), had fewer years of opioid dependence (7 versus 14, p < 0.001), were less likely to have a history of IDU (35% versus 54%, p = 0.07), and had lower rates of hepatitis C (25% versus 61%, p = 0.002) than subjects with prior methadone treatment. Abstinence and treatment retention were comparable in both groups. The results suggest that office-based treatment of opioid dependence is associated with new types of patients entering into treatment. Treatment outcomes with buprenorphine in a PCC do not vary based on history of prior methadone treatment.

Introduction

Heroin and prescription opioid abuse have increased substantially, widening the gap between the number needing and receiving treatment for opioid dependence. Limited access has contributed to the discrepancy between those needing and receiving treatment. In the U.S., the Drug Addiction Treatment Act (2000) allows qualified physicians to provide buprenorphine from their office. In 2002, buprenorphine was approved for the treatment of opioid dependence (Jaffe and O’Keeffe, 2003). These moves were designed to broaden access to care by bringing new patients into treatment (Fiellin and O’Connor, 2002a, Fiellin and O’Connor, 2002b).

Little is known about whether office-based buprenorphine is associated with new patients entering treatment. Similarly, the differences in clinical characteristics and treatment outcomes of patients receiving office-based buprenorphine who have not received methadone maintenance (new-to-treatment) versus those who have received methadone (previously treated), remain uncharacterized.

The purpose of this study is to evaluate whether the practice of office-based buprenorphine treatment in a Primary Care Clinic (PCC) is associated with a different patient population receiving treatment compared to patients enrolling in methadone maintenance in an Opioid Treatment Program (OTP). In addition, we evaluated clinical characteristics and treatment outcomes in new versus previously treated patients amongst those receiving office-based buprenorphine.

Section snippets

Study design

We performed a cross-sectional analysis of the baseline data on patients enrolling in a trial of buprenorphine in a PCC from August 2000 through December 2001, and methadone in an OTP from July 2001 through December 2001.We performed a stratified analysis of the PCC patients based on whether they were new-to-treatment to determine whether the two groups differed in demographic, clinical and substance use characteristics, and treatment outcomes.

Settings

The settings included the PCC of Yale-New Haven

Results

Patients enrolling in the PCC (N = 96) and in the OTP (N = 94) were similar in age, race, and education, but a greater proportion of the PCC samples were male (77% versus 55%, p = 0.002) or full-time employed (46% versus 15%, p < 0.001) (Table 1). The PCC group had a lower proportion of patients with a history of methadone treatment compared to those entering the OTP (46% versus 61%, p < 0.05). The proportion using heroin as the primary opioid was similar in the two groups (94% versus 90%). Patients

Discussion

This study suggests that buprenorphine maintenance in a PCC may be associated with provision of treatment to a different patient population than is currently receiving methadone. Patients enrolling in office-based treatment were more likely to be male, employed, have fewer years of opioid dependence, lower rates of IDU, and have no history of methadone treatment, compared to contemporaneous controls enrolling in a nearby methadone clinic. Within the PCC, new-to-treatment patients were younger,

Acknowledgements

Dr. Sullivan is supported by the National Institute on Drug Abuse Physician Scientist Award (NIDA #K12 DA00167) and Dr. Fiellin is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

References (10)

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This work was presented at the Annual Meeting of the College on Problems of Drug Dependence, June 14–19, 2003, Bal Harbour, Florida.

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