Home- versus Office-based Buprenorphine Induction: Impact on 30-Day Retention

In this observational study, the authors compared 30-day treatment retention between opioid-dependent patients who chose office-based buprenorphine induction and those who chose home-based induction. Over the 3-year study period, 115 of 298 opioid-dependent patients presenting to an urban health center met eligibility criteria and were included in the sample. Office-based induction (n=64) consisted of a preparatory visit, an initial induction visit over 2–4 hours, a second 20-minute induction visit 1–2 days later, and transition into maintenance. Home-based induction (n=51) consisted of a preparatory visit, a return visit to collect a home induction kit (including detailed instructions, 3 days of buprenorphine/naloxone, ibuprofen, clonidine, and loperamide), and follow-up 1 week before transition into maintenance. The groups did not differ in baseline demographic and drug use characteristics.

• Thirty-day treatment retention was similar between groups (78.1% in the office-based group and 78.4% in the home-based group [p=0.97]).

Comments:

Although this observational study was limited by its small sample size, lack of randomization, and reliance on medical-record review rather than research-based data collection, the results add to the growing literature demonstrating the feasibility of unobserved buprenorphine home inductions among opioid-dependent patients. Randomized controlled trials are needed to assess differences in adverse events, treatment retention, and abstinence.

Jeanette M. Tetrault, MD

Reference:

Sohler NL, Li X, Kunins HV, et al. Home- versus office-based buprenorphine inductions for opioid-dependent patients. J Subst Abuse Treat. 2010;38(2):153–9.