title: Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial.
abstract: OBJECTIVE
  Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.
  
  
  OBJECTIVE
  To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.
  
  
  METHODS
  From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.
  
  
  METHODS
  Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage).
  
  
  METHODS
  Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).
  
  
  RESULTS
  During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.
  
  
  CONCLUSIONS
  Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00987961.
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Liebschutz
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
authors.forename: Denise
authors.initials: D
authors.lastname: Crooks
authors.affiliation: Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Debra
authors.initials: D
authors.lastname: Herman
authors.affiliation: Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Bradley
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Judith
authors.initials: J
authors.lastname: Tsui
authors.affiliation: Department of Psychology, The University of Memphis, Memphis, Tennessee.
authors.forename: Lidia Z
authors.initials: LZ
authors.lastname: Meshesha
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
authors.forename: Shernaz
authors.initials: S
authors.lastname: Dossabhoy
authors.affiliation: Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Michael
authors.initials: M
authors.lastname: Stein
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010351:Patient Discharge; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D002047:Buprenorphine
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