title: A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic.
abstract: OBJECTIVE
  Buprenorphine is an alternative to methadone for the maintenance treatment of heroine dependence and may be effective on a thrice weekly basis. Our objective was to evaluate the effect of thrice weekly buprenorphine maintenance for the treatment of heroin dependence in a primary care clinic on retention in treatment and illicit opioid use.
  
  
  METHODS
  Opioid-dependent patients were randomly assigned to receive thrice weekly buprenorphine maintenance in a primary care clinic that was affiliated with a drug treatment program (n = 23) or in a traditional drug treatment program (n = 23) in a 12-week clinical trial. Primary outcomes were retention in treatment and urine toxicology for opioids; secondary outcomes were opioid withdrawal symptoms and toxicology for cocaine.
  
  
  RESULTS
  Retention during the 12-week study was higher in the primary care setting (78%, 18 of 23) than in the drug treatment setting (52%, 12 of 23; P = 0.06). Patients admitted to primary care had lower rates of opioid use based on overall urine toxicology (63% versus 85%, P < 0.01) and were more likely to achieve 3 or more consecutive weeks of abstinence (43% versus 13%, P = 0.02). Cocaine use was similar in both settings.
  
  
  CONCLUSIONS
  Buprenorphine maintenance is an effective treatment for heroin dependence in a primary care setting.
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: A H
authors.initials: AH
authors.lastname: Oliveto
authors.forename: J M
authors.initials: JM
authors.lastname: Shi
authors.forename: E G
authors.initials: EG
authors.lastname: Triffleman
authors.forename: K M
authors.initials: KM
authors.lastname: Carroll
authors.forename: T R
authors.initials: TR
authors.lastname: Kosten
authors.forename: B J
authors.initials: BJ
authors.lastname: Rounsaville
authors.forename: J A
authors.initials: JA
authors.lastname: Pakes
authors.forename: R S
authors.initials: RS
authors.lastname: Schottenfeld
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003042:Cocaine / Q000652:urine; D004334:Drug Administration Schedule; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010352:Patient Dropouts; D011320:Primary Health Care; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D003042:Cocaine