Short communicationThe practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into 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.
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2016, Drug and Alcohol DependenceCitation Excerpt :Those who received both buprenorphine and methadone in the same year appeared to share similar characteristics as those who received buprenorphine only. Our data is supportive of the earlier suggestions that patients who use buprenorphine tend to be representative of new types of OUD patients, people who likely developed problems with opiate use more recently, and were more likely to be younger, white and employed compared to methadone enrolled patients (Stanton, 2006; Sullivan et al., 2005). This demographic pattern of OUD treatment population seems to parallel changes in the characteristics of opioid users in the US in recent decades.
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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.