title: Integrating buprenorphine maintenance therapy into federally qualified health centers: real-world substance abuse treatment outcomes.
abstract: BACKGROUND
  Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs).
  
  
  METHODS
  Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months.
  
  
  RESULTS
  Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days.
  
  
  CONCLUSIONS
  Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.
authors: Community Health Center, Inc., Middletown, CT, USA. haddadm@chc1.com
authors: Marwan S
authors: MS
authors: Haddad
authors: Alexei
authors: A
authors: Zelenev
authors: Frederick L
authors: FL
authors: Altice
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D060046:Maintenance Chemotherapy / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D058991:Patient Protection and Affordable Care Act / Q000639:trends; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002047:Buprenorphine