A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic.
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.
O'Connor
P G
PG
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
Oliveto
A H
AH
Shi
J M
JM
Triffleman
E G
EG
Carroll
K M
KM
Kosten
T R
TR
Rounsaville
B J
BJ
Pakes
J A
JA
Schottenfeld
R S
RS
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
D009292:Narcotic Antagonists; D002047:Buprenorphine; D003042:Cocaine