title: Buprenorphine for acute heroin detoxification: diffusion of research into practice.
abstract: Buprenorphine has been approved for heroin detoxification, but little is known about its impact on everyday practice. Concerns about buprenorphine include expense, limited knowledge about its use, patient limits, and social and clinical attitudes regarding opioid treatment for heroin dependence. On the other hand, randomized clinical trials suggest that buprenorphine is superior to clonidine with regard to withdrawal symptom relief. In June 2004, a community-based residential medical detoxification center switched from clonidine to buprenorphine treatment for all new and returning heroin clients. This study is a retrospective chart review of subject outcomes with clonidine (n = 100) versus buprenorphine (n = 100). Bivariate analysis suggested few cohort differences in pretreatment demographics and client characteristics. In contrast, buprenorphine was significantly associated with increased length of stay and treatment completion. The positive associations between buprenorphine and both treatment completion and length of stay persisted and were slightly enhanced after regression analysis adjusted for potential confounders. Additionally, clinical staff reported better subject engagement in treatment and psychosocial group sessions. This single-site study is an example of successful integration of an evidence-based treatment into community-based practice.
authors.affiliation: Department of Psychiatry, Oregon Health and Science University, Portland, OR 97239, USA. kovasa@ohsu.edu
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: McCarty
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Boverman
authors.forename: James A
authors.initials: JA
authors.lastname: Thayer
mesh_terms: D000208:Acute Disease; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use; D004059:Diffusion of Innovation; D005260:Female; D003932:Heroin / Q000009:adverse effects*; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009922:Oregon; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D003932:Heroin; D003000:Clonidine