title: Buprenorphine retention in primary care.
abstract: BACKGROUND
  This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist.
  
  
  METHODS
  Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after the adoption of buprenophine/naloxone by a primary care practice in Rhode Island. Practice policy precluded patient discharges due to continuing drug use.
  
  
  RESULTS
  Patients (n=41) had a mean duration of opioid use of 15.7 years and most had a history of heroin use (63.4%). Thirty-nine percent of patients transferred from methadone maintenance. At 24 weeks, 59% remained in treatment. Nearly half of dropouts occurred in the first 30 days. Participants with opiate-positive toxicologies at week 1 were more likely to drop out of the program (P<.01) and had a significantly shorter retention time (P<.01) on average. Among other drug use and drug treatment variables, employment and addiction counseling during treatment were significantly associated with treatment retention (P=.03).
  
  
  CONCLUSIONS
  Retention rates in a real world, primary care-based buprenorphine maintenance practice reflect those reported in clinical trials. Abstinence during the first week of treatment and receipt of counseling were critical to patient retention.
authors.affiliation: Division of General Internal Medicine, Rhode Island Hospital, Providence, RI 02903, USA. mstein@lifespan.org
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.forename: Patricia
authors.initials: P
authors.lastname: Cioe
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002047:Buprenorphine / Q000627:therapeutic use* / Q000652:urine; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000819:agonists* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010352:Patient Dropouts; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone