Buprenorphine Maintenance is More Effective than Taper for Treating Prescription Opioid Use Disorder in Primary Care

Buprenorphine is an important treatment option for opioid use disorder and can be prescribed as a gradual taper or maintenance treatment. This trial recruited 113 subjects with DSM-IV prescription opioid dependence in a primary care practice. All participants underwent a 2-week buprenorphine induction, then randomly received either a stable dosage of buprenorphine for 4 weeks, followed by a gradual taper over 3 weeks (taper), or a stable dose for 14 weeks (maintenance). All subjects received weekly drug counseling.

• Subjects assigned to taper had a lower mean percentage of opioid-negative urine samples than those assigned to maintenance (35% versus 53%). The difference was observed primarily during the second half of the trial (33% versus 64%).
• During the second half of the trial, subjects assigned to taper reported more mean days of opioid use in the past week than those in the maintenance group (1.3 versus 0.5).
• Subjects assigned to taper achieved fewer mean maximum consecutive weeks of opioid abstinence than those assigned to maintenance (2.7 versus 5.2) and were less likely to complete the trial (11% versus 66%).

Comments:

This study confirms that opioid agonist maintenance treatment is more effective than even a prolonged taper and reinforces that we should not place arbitrary time limits on treatment or pressure patients to taper their dose. It also adds to the growing body of evidence demonstrating that this treatment can be provided in a primary care setting, but more primary care physicians need to do this in order to meet the tremendous need.

Darius A. Rastegar, MD

Reference:

Fiellin DA, Schottenfeld RS, Cutter CJ, et al. Primary care-based buprenorphine taper vs maintenance therapy for prescription opioid dependence: a randomized clinical trial. JAMA Intern Med. 2014;174:1947–1954.