Primary Care Office-based Buprenorphine Treatment: Comparison of Heroin and Prescription Opioid Dependent Patients
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Prescription opioid dependence is increasing, but treatment outcomes with office-based buprenorphine/naloxone among these patients have not been described.
We compared demographic, clinical characteristics and treatment outcomes among 200 patients evaluated for entry into a trial of primary care office-based buprenorphine/naloxone treatment stratifying on those who reported exclusive heroin use (n = 124), heroin and prescription opioid use (n = 47), or only prescription opioid use (n = 29).
Compared to heroin-only patients, prescription-opioid-only patients were younger, had fewer years of opioid use, and less drug treatment history. They were also more likely to be white, earned more income, and were less likely to have Hepatitis C antibodies. Prescription-opioid-only patients were more likely to complete treatment (59% vs. 30%), remained in treatment longer (21.0 vs. 14.2 weeks), and had a higher percent of opioid-negative urine samples than heroin only patients (56.3% vs. 39.8%), all p values < .05. Patients who used both heroin and prescription opioids had outcomes that were intermediate between heroin-only and prescription-opioid-only patients.
Individuals dependent on prescription opioids have an improved treatment response to buprenorphine/naloxone maintenance in an office-based setting compared to those who exclusively or episodically use heroin.
KEY WORDSbuprenorphine/therapeutic use primary health care opioid-related disorders
This research was supported by grants from the National Institute on Drug Abuse (NIDA DA09803 and DA19246, Richard S. Schottenfeld, PI). Drs. Fiellin and Sullivan were supported by the NIDA Physician Scientist Award (K12 DA00167). Dr. Fiellin is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. The PIs and the first author had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Potencial Financial Conflict of Interest
Dr. Pantalon reported being a consultant for Bristol-Myers Squibb, and Dr. Schottenfeld reported owning stock in astra Zeneca, GlaxoSmithKline, Pfizer, Sanofi-Synthelab, Wyeth, and Stryker Corporation. The other authors reported no conflicts of interest.
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