title: Factors associated with complicated buprenorphine inductions.
abstract: Despite data supporting its efficacy, barriers to implementation of buprenorphine for office-based treatment are present. Complications can occur during buprenorphine inductions, yet few published studies have examined this phase of treatment. To examine factors associated with complications during buprenorphine induction, we conducted a retrospective chart review of the first 107 patients receiving buprenorphine treatment in an urban community health center. The primary outcome, defined as complicated induction (precipitated or protracted withdrawal), was observed in 18 (16.8%) patients. Complicated inductions were associated with poorer treatment retention (than routine inductions) and decreased over time. Factors independently associated with complicated inductions included recent use of prescribed methadone, recent benzodiazepine use, no prior experience with buprenorphine, and a low initial dose of buprenorphine/naloxone. Findings from this study and further investigation of patient characteristics and treatment characteristics associated with complicated inductions can help guide buprenorphine treatment strategies.
authors.affiliation: New York University School of Medicine and Bellevue Hospital Center, New York, NY 10016, USA. susan.whitley@nyumc.org
authors.forename: Susan D
authors.initials: SD
authors.lastname: Whitley
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sohler
authors.forename: Hillary V
authors.initials: HV
authors.lastname: Kunins
authors.forename: Angela
authors.initials: A
authors.lastname: Giovanniello
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.forename: Galit
authors.initials: G
authors.lastname: Sacajiu
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003151:Community Health Centers; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D019037:Urban Health Services
chemical_list: D009292:Narcotic Antagonists; D001569:Benzodiazepines; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone