Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings.
OBJECTIVE
Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in non-research clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings.


METHODS
We studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use.


RESULTS
Fifty-four percent of patients were sober at 6 months. There was no significant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.


CONCLUSIONS
Opioid-addicted patients can be safely and effectively treated in non-research primary care settings with limited on-site resources. Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings.
Mintzer
Ira L
IL
Harvard Medical School/Cambridge Health Alliance, Cambridge, MA 02139, USA. imintzer@challiance.org
Eisenberg
Mark
M
Terra
Maria
M
MacVane
Casey
C
Himmelstein
David U
DU
Woolhandler
Steffie
S
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003153:Community Health Services / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010044:Outpatient Clinics, Hospital; D011320:Primary Health Care / Q000379:methods*; D012657:Self-Help Groups; D016896:Treatment Outcome
D004338:Drug Combinations; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine