Buprenorphine Treatment in Less Specialized Settings: Can It Work?
Buprenorphine treatment outcomes are generally evaluated in resource-rich settings (e.g., with research staff) or in patients with some social support. The effectiveness of this treatment in everyday practice settings and among more destitute patients remains unclear. Two studies explored more generalizable approaches to buprenorphine treatment for opioid dependence.
Researchers in the Boston area assessed 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). Clinical outcomes did not differ across the treatment settings.
Other Boston researchers compared the effectiveness of buprenorphine in patients treated at a clinic for the homeless (n=44) and in housed patients treated at a general primary care setting (n=41). A nurse care manager was actively engaged in patients’ care at both sites.
Although homeless patients had many more comorbidities than housed patients, treatment outcomes were similar between the groups:
- Twenty-one percent of homeless patients and 22% of housed patients “failed treatment.”*
- Both groups had a median treatment retention of 9 months. Of those in treatment for 12 months, 4% of both groups used illicit opioids.
- Homelessness resolved for 36%, and employment rates increased in both groups.
The above findings support the effectiveness of extending office-based buprenorphine treatment into less specialized, low-intensity settings and to patients with only marginal social support. These feasibility and effectiveness studies should extend the reach of buprenorphine treatment for opioid dependence.Marc N. Gourevitch, MD, MPH
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.