title: The practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment?
abstract: Office-based buprenorphine holds the promise of bringing patients who have never received pharmacotherapy into treatment. In a cross-sectional and longitudinal analysis, we compared patients entering a clinical trial of buprenorphine in a Primary Care Clinic (PCC) and those entering a local Opioid Treatment Program (OTP) and we compared the clinical characteristics and treatment outcomes of PCC patients with no history of methadone treatment (new-to-treatment) to those with prior methadone treatment. PCC subjects (N=96) were enrolled in a 26-week randomized clinical trial of office-based buprenorphine/naloxone provided in a PCC. OTP subjects (N=94) were enrolled in methadone maintenance during the same time period. PCC subjects compared with OTP subjects were more likely to be male (77% versus 55%, p<0.01), full-time employed (46% versus 15%, p<0.001), have no history of methadone treatment (46% versus 61%, p<0.05), have fewer years of opioid dependence (10 versus 15, p<0.001), and lower rates of injection drug use (IDU) (44% versus 60%, p=0.03). The new-to-treatment PCC subjects were younger (36 years versus 41 years, p=0.001), more likely to be white (77% versus 57%, p=0.04), had fewer years of opioid dependence (7 versus 14, p<0.001), were less likely to have a history of IDU (35% versus 54%, p=0.07), and had lower rates of hepatitis C (25% versus 61%, p=0.002) than subjects with prior methadone treatment. Abstinence and treatment retention were comparable in both groups. The results suggest that office-based treatment of opioid dependence is associated with new types of patients entering into treatment. Treatment outcomes with buprenorphine in a PCC do not vary based on history of prior methadone treatment.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208025, New Haven, CT 06520-8025, USA. lynn.sullivan@yale.edu
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sullivan
authors.forename: Marek
authors.initials: M
authors.lastname: Chawarski
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schottenfeld
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002047:Buprenorphine / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009819:Office Visits; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010818:Practice Patterns, Physicians'
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine