Buprenorphine treatment for opioid dependence has been provided in office-based settings in the United States for several years now. However, little is known about the patients receiving buprenorphine in these settings. Therefore, researchers conducted this study of 86 patients receiving the opioid treatment from 6 office-based physicians (all with at least 1 board certification in psychiatry or addiction psychiatry, or a specialty in addiction treatment) in New York City. Most subjects were white and had a job, housing, and support (financial and emotional); 41% had not been in previous treatment or participated in 12-step groups.

• According to a review of patient’s medical records, 50% were misusing a prescription opioid at intake and 35% were using heroin; 9% were both misusing a prescription opioid and using heroin. The remaining subjects were either transferring from other treatment, had cravings, or had fear of relapse.
• Almost 50% reported using non-opioid drugs (e.g., cocaine, marijuana) at intake.
• Sixty-three percent of patients received prescriptions for at least 1 psychiatric medication during buprenorphine treatment.
• Time in buprenorphine treatment ranged from <1 to 30 months (median 8 months).
• According to the last entry in the medical record, 24% were misusing any substance and 8% were misusing opioids. Fifty-two percent were still receiving buprenorphine from the physician they saw at intake.
  • Factors associated with retention in buprenorphine treatment included full-time employment or other forms of support, stable housing, and prescription opioid misuse at intake. Psychiatric disorders or substance misuse during treatment did not affect retention.

Comments by Michael G. Boyle, MA:
These results are difficult to generalize. Physicians were mental health or addiction specialists (rather than primary care physicians), and subjects differed markedly from those who seek treatment from publicly funded, community-based treatment institutions. Further, most subjects had significant “recovery capital” and may not have been enmeshed in a culture of addiction.

More studies of buprenorphine treatment models among populations with differing characteristics are needed. However, this study suggests that office-based buprenorphine treatment is an attractive and effective option for people with opiate problems who would otherwise avoid treatment via the traditional system (because, as the authors note, of stigma associated with methadone and the necessity of daily attendance at a clinic for dosing in the early stage of treatment).