A case series of buprenorphine/naloxone treatment in a primary care practice.
Physicians' adoption of buprenorphine/naloxone treatment is hindered by concerns over feasibility, cost, and lack of comfort treating patients with addiction. We examined the use of buprenorphine/naloxone in a community practice by two generalist physicians without addiction training, employing a retrospective chart review. From 2006-2010, 228 patients with opiate abuse/dependence were treated with buprenorphine/naloxone using a home-induction protocol. Multiple co-morbidities including diabetes (23% of patients), hypertension (36%), Hepatitis C (43%), and depression (74%) were concurrently managed. In this diverse sample, 1/228 experienced precipitated withdrawal during induction. Of the convenience subsample analyzed (n = 28), 82% (+/-10%) had negative urine drug tests for opioids; 92% (+/-11%) were negative for cocaine; 88% (+/-12%) were positive for buprenorphine. This case series demonstrated feasibility and safety of a low-cost buprenorphine/naloxone home induction protocol employed by generalists. Concurrent treatment of multiple comorbidities conforms with the patient-centered medical home ideal. Randomized trials of this promising approach are needed.
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8030, USA.
Benjamin
B
Doolittle
William
W
Becker
D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D015897:Comorbidity; D004338:Drug Combinations; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012646:Self Administration / Q000706:statistics & numerical data*
D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D009270:Naloxone; D002047:Buprenorphine