Who Receives and Remains in Office-Based Buprenorphine Treatment?
Buprenorphine treatment for opioid dependence has been provided in office-based settings in the United States for several years now. Data on patients receiving buprenorphine in these settings, however, are lacking. Therefore, researchers analyzed data from a medical record review of 86 patients receiving office-based buprenorphine treatment from 6 physicians in New York City.
- One-half of patients were misusing a prescription opioid at intake, 35% were using heroin, and 9% were using both. The remaining subjects were either transferring from other treatment, had cravings, or had fear of relapse.
- Almost 50% reported misusing 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.
- The median time in treatment was 8 months (range <1 to 30 months).
- According to the last entry in the medical record, 24% were misusing any substance and 8% were misusing opioids. Fifty-eight percent were still receiving buprenorphine (52% from the index physician).
- Factors associated with retention in buprenorphine treatment with the index physician included full-time employment or other forms of support, stable housing, and prescription opioid (versus heroin) misuse at intake. Psychiatric disorders or substance misuse during treatment did not affect retention.
This is one of a growing number of descriptive studies of unselected patients receiving office-based buprenorphine treatment. It demonstrates that successful buprenorphine treatment can be achieved in office-based settings. To ensure successful treatment in these patients who often have psychiatric comorbidity, strong referral networks and access to consultation for complex cases are desirable.Julia H. Arnsten, MD, MPH
Magura S, Lee SJ, Salsitz EA, et al. Outcomes of buprenorphine maintenance in office-based practice. J Addict Dis. 2007;26(2):13–23.