Office-Based Buprenorphine Treatment Just as Effective for People with Opioid Dependence Who Use Cocaine as for Those Who Do Not

Previous research has found that people with opioid dependence who also use cocaine tend not to do as well on methadone maintenance treatment as those without concurrent cocaine use. The impact of cocaine use on outcomes in office-based buprenorphine treatment is less clear. Researchers followed a cohort of 87 participants who initiated buprenorphine treatment for opioid dependence in a community health center and interviewed them at 1, 3, and 6 months. The main outcome measures were retention in treatment and self-reported opioid use.

• Overall, 39% of participants reported using cocaine in the month prior to initiation of treatment. People with cocaine use were younger and more likely to use opioid analgesics.
• Cocaine use declined to 33% at 1 month, 19% at 3 months, and 12% at 6 months.
• Treatment retention at 6 months was not significantly different for people with cocaine use (59%), versus those without (51%) and self-reported opioid use was likewise not significantly different (~27% for both).

Comments:

This study, although limited by short duration, small sample size, and reliance on self-report, suggests that concurrent cocaine use should not be a reason to deny a person access to office-based buprenorphine treatment for opioid dependence. It is interesting that treatment retention was somewhat better among people with cocaine use; this has been observed in at least one previous study. One concern is whether people who use cocaine are more likely to divert buprenorphine. It is possible that for some of these individuals, cocaine is the drug of choice and patients may use their access to buprenorphine to obtain cocaine; this should be studied further.

Darius A. Rastegar, MD

Reference:

Cunningham CO, Giovanniello A, Kunins HV, et al. Buprenorphine treatment outcomes among opioid-dependent cocaine users and non-users. Am J Addict. 2013;22(4):352–357.