title: Improving temporal efficiency of outpatient buprenorphine induction.
abstract: Buprenorphine induction poses a barrier for physician adoption of office-based opioid dependence treatment. We conducted a retrospective chart review of the first 41 patients inducted at a newly established outpatient treatment program to examine the induction process and determine strategies associated with greater induction efficiency. Timed withdrawal scales, medication log, and notes enabled reconstruction of the initial day of buprenorphine treatment. To assess change with experience, consecutive patients were divided into three chronological groups for analyses (Phases 1-3). The time required for induction was substantial in Phase 1 (mean 5.5 hours), but temporal efficiency improved to a mean 1.5 hours spent at the program by Phase 3 (p < .001). Phase 2-3 patients arrived to the program after significantly longer opioid abstinence and were in greater withdrawal, with mean Clinical Opioid Withdrawal Scale scores of 6, 10, and 10 for Phases 1-3, respectively (p < .01). Patients in the later phases had less time delay to medication initiation, 5 minutes in Phase 3 compared to 133 minutes in Phase 1 (p < .001). The mean 7-mg buprenorphine dose administered in the office did not differ between groups, but occurred over a smaller time interval for later phases indicating more rapid titration. Patients in the later phases had more rapid withdrawal relief after buprenorphine initiation and were more likely to have used preinduction ancillary withdrawal medication. The study sheds light on the induction barrier and provides practical procedural information to inform clinical guidelines and hopefully mitigate procedural aspects of the induction barrier.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA. erikgunderson@virginia.edu
authors.forename: Erik W
authors.initials: EW
authors.lastname: Gunderson
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Rombone
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Vosburg
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Kleber
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D013997:Time Factors
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine