Buprenorphine Treatment in Less Specialized Settings: Can It Work?

Buprenorphine Treatment in Less Specialized Settings: Can It Work?
January 2008

Research Summary and Comments

The effectiveness of buprenorphine treatment is usually evaluated in resource-rich settings (e.g., with research staff) or among patients with some social support. The treatment’s effectiveness in everyday practice settings and for patients without support remains unclear and is the focus of two recent studies.

Researchers in the Boston area studied 99 patients receiving buprenorphine treatment in (1) a hospital-based primary care center with an on-site pharmacy but no on-site addiction counselor or (2) a neighborhood health center with an on-site addiction counselor but no on-site pharmacy. At 6 months, 54% of patients were “sober” (determined by the treating physician and based on urine toxicology, self-reported drug use, and clinical assessment). Results did not differ across the two treatment settings. Staff reported no instances of disruptive behaviors among any of the patients receiving buprenorphine treatment.

Other Boston researchers compared the effectiveness of buprenorphine in 44 patients treated at a clinic for the homeless and in 41 housed patients treated at a general primary care setting. A nurse care manager was actively engaged in patients’ care at both sites. Although homeless patients had many more comorbidities (particularly self-reported psychiatric illness, Hepatitis C, and HIV) than did housed patients, treatment outcomes were similar between the groups:

Twenty-one percent of homeless patients and 22% of housed patients “failed treatment.”*
Both groups remained in treatment for a median of 9 months.
Of patients in treatment for 12 months, 4% in both groups used illicit opioids.
Employment rates increased in both groups and 36% were no longer homeless.

* Left during treatment initiation or was discharged because of either disruptive behavior (which was rare) or ongoing alcohol or other drug use while not adhering to intensified substance abuse treatment.

Comments by Tommie Ann Bower, MA
These studies should encourage programs, even those without a full range of supports, to expand access to buprenorphine. Particularly promising is the use of buprenorphine with more compromised patients. It may be useful to provide education and support to staff to achieve their buy-in when new treatment regimens to new populations are introduced.

Reference:
Mintzer IL, Eisenberg M, Terra M, et al. Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Fam Med. 2007;5(2):146–150. Alford DP, LaBelle CT, Richardson JM, et al. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med. 2007;22(2):171–176.

This summary was adapted from text previously published in Alcohol, Other Drugs, and Health: Current Evidence.