title: Interim buprenorphine treatment in opiate dependence: A pilot effectiveness study.
abstract: BACKGROUND
  Interim methadone treatment (i.e., temporary medication-only treatment) has been tested in a few U.S. studies as a method for facilitated referral to and initiation of opioid maintenance treatment in heroin dependence. However, despite the favorable safety profile of buprenorphine compared with methadone, interim treatment with buprenorphine rarely has been tested and reported in the scientific literature. The present pilot effectiveness study aims to assess the feasibility of an interim buprenorphine treatment for initiation of individuals with opiate dependence into full-scale opioid maintenance treatment, and to study baseline predictors of successful transfer to full-scale treatment.
  
  
  METHODS
  Interim treatment was introduced in a high-threshold setting with waiting lists to opioid maintenance treatment. Consecutive patients on the waiting list were offered the option to enter interim treatment. The interim program was a medication-only condition with supervised daily doses of buprenorphine-naloxone. The main outcome was successful transfer to full-scale opioid maintenance treatment, which required a drug-free urine sample.
  
  
  RESULTS
  Forty-four patients entered interim buprenorphine treatment. Among them, 57% (n = 25) were successfully transferred to full-scale treatment after an average of 44 days. Remaining patients could not be transferred, generally because they did not manage to become drug-free. Successful transfer to full-scale treatment was associated with a lower baseline Alcohol Use Disorders Identification Test (AUDIT) score (4.4 vs. 12.6; P < .001) and tended to be associated with lower cannabis use (5.2 vs. 10.4 days during the past 30 days; P = .06) and lower heroin use (7.2 vs. 9.9 days; P = .09) prior to baseline. In a logistic regression analysis, only lower AUDIT score predicted successful treatment entry.
  
  
  CONCLUSIONS
  According to these pilot data, supervised buprenorphine-naloxone in a medication-only interim treatment condition appears to be a feasible way to improve treatment initiation in a high-threshold setting. Polydrug use, including higher levels of alcohol consumption, may predict a more complicated course in interim treatment.
authors.affiliation: a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.
authors.forename: Tove
authors.initials: T
authors.lastname: Abrahamsson
authors.affiliation: a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.
authors.forename: Carolina
authors.initials: C
authors.lastname: Widinghoff
authors.affiliation: a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Lilliebladh
authors.affiliation: a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.|b Department of Psychiatry Lund , Psychiatry Skane , Lund , Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gedeon
authors.affiliation: b Department of Psychiatry Lund , Psychiatry Skane , Lund , Sweden.|c Helsingborg General Hospital , Helsingborg , Sweden.
authors.forename: Kent
authors.initials: K
authors.lastname: Nilvall
authors.affiliation: a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Hakansson
mesh_terms: D000328:Adult; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000652:urine; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists
keywords: Buprenorphine; interim treatment; opioid maintenance treatment; opioid-related disorders