title: Prior buprenorphine experience is associated with office-based buprenorphine treatment outcomes.
abstract: OBJECTIVE
  As buprenorphine treatment and illicit buprenorphine use increase, many patients seeking buprenorphine treatment will have had prior experience with buprenorphine. Little evidence is available to guide optimal treatment strategies for patients with prior buprenorphine experience. We examined whether prior buprenorphine experience was associated with treatment retention and opioid use. We also explored whether type of prior buprenorphine use (prescribed or illicit use) was associated with these treatment outcomes.
  
  
  METHODS
  We analyzed interview and medical record data from a longitudinal cohort study of 87 individuals who initiated office-based buprenorphine treatment. We examined associations between prior buprenorphine experience and 6-month treatment retention using logistic regression models, and prior buprenorphine experience and any self-reported opioid use at 1, 3, and 6 months using nonlinear mixed models.
  
  
  RESULTS
  Most (57.4%) participants reported prior buprenorphine experience; of these, 40% used prescribed buprenorphine and 60% illicit buprenorphine only. Compared with buprenorphine-naïve participants, those with prior buprenorphine experience had better treatment retention (adjusted odds ratio [AOR] = 2.65, 95% CI = 1.05-6.70). Similar associations that did not reach significance were found when exploring prescribed and illicit buprenorphine use. There was no difference in opioid use when comparing participants with prior buprenorphine experience with those who were buprenorphine-naive (AOR = 1.33, 95% CI = 0.38-4.65). Although not significant, qualitatively different results were found when exploring opioid use by type of prior buprenorphine use (prescribed buprenorphine vs buprenorphine-naïve, AOR = 2.20, 95% CI = 0.58-8.26; illicit buprenorphine vs buprenorphine-naïve, AOR = 0.47, 95% CI = 0.07-3.46).
  
  
  CONCLUSIONS
  Prior buprenorphine experience was common and associated with better retention. Understanding how prior buprenorphine experience affects treatment outcomes has important clinical and public health implications.
authors.affiliation: From the Albert Einstein College of Medicine (COC, RJR, JLS, AG) and Montefiore Medical Center (COC, RJR, JLS, AG), Bronx; and Sophie Davis School of Biomedical Education (NLS), City College of the City University of New York, NY.
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Roose
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Starrels
authors.forename: Angela
authors.initials: A
authors.lastname: Giovanniello
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sohler
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D002047:Buprenorphine