title: Buprenorphine dose induction in non-opioid-tolerant pre-release prisoners.
abstract: BACKGROUND
  In a previously reported randomized controlled trial, formerly opioid-dependent prisoners were more likely to enter community drug abuse treatment when they were inducted in prison onto buprenorphine/naloxone (hereafter called buprenorphine) than when they received counseling without buprenorphine in prison (47.5% vs. 33.7%, p=0.012) (Gordon et al., 2014). In this communication we report on the results of the induction schedule and the adverse event profile seen in pre-release prisoners inducted onto buprenorphine.
  
  
  METHODS
  This paper examines the dose induction procedure, a comparison of the proposed versus actual doses given per week, and side effects reported for 104 adult participants who were randomized to buprenorphine treatment in prison. Self-reported side effects were analyzed using generalized estimated equations to determine changes over time in side effects.
  
  
  RESULTS
  Study participants were inducted onto buprenorphine at a rate faster than the induction schedule. Of the 104 (72 males, 32 females) buprenorphine recipients, 64 (37 males, 27 females) remained on medication at release from prison. Nine participants (8.6%) discontinued buprenorphine because of unpleasant opioid side effects. There were no serious adverse events reported during the in-prison phase of the study. Constipation was the most frequent symptom reported (69 percent).
  
  
  CONCLUSIONS
  Our findings suggest that buprenorphine administered to non-opioid-tolerant adults should be started at a lower, individualized dose than customarily used for adults actively using opioids, and that non-opioid-tolerant pre-release prisoners can be successfully inducted onto therapeutic doses prior to release.
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA. Electronic address: fvocci@friendsresearch.org.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Vocci
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
authors.forename: Monique E
authors.initials: ME
authors.lastname: Wilson
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; Stevenson University, Department of Criminal Justice, 1525 Greenspring Valley Road, Stevenson, MD 21153, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Gordon
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; University of Baltimore, School of Criminal Justice, College of Public Affairs, 1420 N. Charles Street, Baltimore, MD 21201, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Kinlock
authors.affiliation: Glenwood Life Counseling Center, 516 Glenwood Avenue, Baltimore, MD 21212, USA.
authors.forename: Terrence T
authors.initials: TT
authors.lastname: Fitzgerald
authors.affiliation: University of Maryland, 8082 Baltimore Avenue, College Park, MD 20740, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; University of Maryland, School of Medicine, Department of Psychiatry, 110 S. Paca Street, Baltimore, MD 21201, USA.
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011329:Prisoners; D011330:Prisons
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination
keywords: Buprenorphine dose; Buprenorphine induction; Opioid-dependent prisoners