title: Using buprenorphine to facilitate entry into residential therapeutic community rehabilitation.
abstract: For opioid-dependent patients, the need for detoxification has been a barrier to entry into long-term residential treatment. This report describes a retrospective observational cohort study with the first 38 opioid-dependent patients entering First Step, a 14-day buprenorphine-naloxone (Suboxone) detoxification regimen integrated into a long-term residential therapeutic community (TC) program. Eighty-nine percent (34 of 38) of First Step patients completed a 14-day buprenorphine taper protocol, 50% (19 of 38) completed an initial 3- to 4-week stay, and 39% (15 of 38) completed at least 3 months of residential treatment at the TC. Retention did not differ significantly in a demographically matched concurrently admitted control group without impending opioid withdrawal, in which 65% (24 of 37) completed an initial 3- to 4-week stay (p = .20) and 57% (21 of 37) completed at least 3 months of treatment (p = .14). Withdrawal symptoms were mild, and there were no instances of precipitated withdrawal. The findings suggest the potential for buprenorphine to serve as a bridge, improving the viability of long-term residential treatment for managing opioid dependence.
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Collins
authors.forename: Terry
authors.initials: T
authors.lastname: Horton
authors.forename: Katherine
authors.initials: K
authors.lastname: Reinke
authors.forename: Leslie
authors.initials: L
authors.lastname: Amass
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D002047:Buprenorphine / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D009460:Neurologic Examination / Q000187:drug effects; D009519:New York City; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D010352:Patient Dropouts / Q000523:psychology; D012114:Residential Treatment; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000523:psychology / Q000534:rehabilitation; D013808:Therapeutic Community
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine