Adherence to Buprenorphine Maintenance Treatment in Opioid Dependence Syndrome: A Case Control Study

Bandawar, Mrunal; Kandasamy, Arun; Chand, Prabhat; Murthy, Pratima; Benegal, Vivek

doi:10.4103/0253-7176.162951

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Second, the retention outcomes at 6 months and 1 year suggests considerable attrition, particularly at the Northeast ICCs. Our findings are comparable to but also differ from findings reported in other studies conducted in India and elsewhere 23,31,33–36,43 . For example, overall retention, and regional retention at 6 months (even in the Northeast ICCs where retention is poorer) are comparable to that reported in other international studies 31,43 and meet internal programmatic benchmarks of at least 50% retention in treatment at 6 months.…”

Section: Discussionsupporting

confidence: 55%

“…Few studies have examined buprenorphine receipt and retention among PWID in public sector and/or public-private service delivery models in India. These studies been limited to five or fewer sites and/or a small number of PWID largely as part of operational research conducted in the initial roll-out of OST in the country 23,[32][33][34][35][36] . In this study, by way of examining buprenorphine initiation, receipt and retention in more granular detail among PWID receiving services at ICCs across 7 cities in India, we constructed an opioid treatment cascade which points to significant programmatic and patient-level gaps as well as notable regional differences.…”

Section: Discussionmentioning

confidence: 99%

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Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

Ganapathi

McFall

Greco

et al. 2022

Preprint

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BackgroundIndia is facing an alarming rise in the injection of opioids leading to burgeoning HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide free single-venue HIV services and substance use treatment to PWID and have been established across 8 Indian cities. We evaluated engagement of PWID in buprenorphine treatment at ICCs to inform interventions.MethodsWe retrospectively analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January – 31 December 2018 across 7 ICCs. We used descriptive statistics to evaluate buprenorphine uptake, receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days but with subsequent re-engagement in treatment), and treatment drop-out (no buprenorphine receipt for 60 consecutive days without subsequent re-engagement), and explore differences between historical opioid epidemic regions (i.e., Northeast cities (NEC)) and emerging opioid epidemic regions (i.e., North/Central/Northwest cities (NCC)). We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months.Results1312 PWID initiated buprenorphine (76% NCC vs. 24% NEC). 31% of PWID in NCC, and 25% in NEC experienced ≥ 1 treatment interruption. About a third (34%) of PWID in NCC vs. half (50%) in NEC dropped-out by 6 months (p<0.0001). Over 6 months, 48% of PWID in NCC vs. 60% in NEC received buprenorphine ≤2 times/week on average (p<0.0001). In multivariable models, living in NEC was associated with increased odds of treatment drop-out while receipt of counseling was associated with decreased odds of treatment drop-out.ConclusionsPWID at ICCs, particularly those in NEC have low buprenorphine receipt and retention. Patient-centered interventions adapted to regional contexts are urgently needed to ameliorate these gaps.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

Ganapathi

McFall

Greco

et al. 2022

Preprint

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“… 41 Similarly, a retrospective case–control study of medical charts of patients (n=248) treated in India for opioid addiction showed that the odds of retention in treatment for patients maintained on buprenorphine is 4.5 ( P <0.005) times greater than patients maintained on oral naltrexone and 7 times ( P <0.001) greater than patients receiving only psychosocial intervention. 42 A 12-week, double-blind randomized clinical trial at a single clinical site in Iran also compared the effectiveness of thrice-weekly dosing of oral naltrexone and sublingual buprenorphine/naloxone for OUD. The findings demonstrated that sublingual buprenorphine/naloxone was associated with a significantly greater mean number of opioid-negative urine tests as well as better treatment retention than oral naltrexone, but neither significantly greater duration of time to relapse to illicit opioid use nor proportions with 12-week abstinence, which ranged from 8% in the naltrexone group to 16% in the buprenorphine group.…”

Section: Efficacy Trials Of Buprenorphine For Oudsmentioning

confidence: 99%

Advances in the delivery of buprenorphine for opioid dependence

Rosenthal¹,

Goradia²

2017

DDDT

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Opioid use disorders (OUDs) have long been a global problem, but the prevalence rates have increased over 20 years to epidemic proportions in the US, with concomitant increases in morbidity and all-cause mortality, but especially opioid overdose. These increases are in part attributable to a several-fold expansion in the prescription of opioid pain medications over the same time period. Opioid detoxification and psychosocial treatments alone have each not yielded sufficient efficacy for OUD, but μ-opioid receptor agonist, partial agonist, and antagonist medications have demonstrated the greatest overall benefit in OUD treatment. Buprenorphine, a μ-opioid receptor partial agonist, has been used successfully on an international basis for several decades in sublingual tablet and film preparations for the treatment of OUD, but the nature of formulation, which is typically self-administered, renders it susceptible to nonadherence, diversion, and accidental exposure. This article reviews the clinical trial data for novel buprenorphine delivery systems in the form of subcutaneous depot injections, transdermal patches, and subdermal implants for the treatment of OUD and discusses both the clinical efficacy of longer-acting formulations through increasing consistent medication exposure and their potential utility in reducing diversion. These new delivery systems also offer new dosing opportunities for buprenorphine and strategies for dosing intervals in the treatment of OUD.

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“…In an important study comparing buprenorphine maintenance, naltrexone maintenance, and psychosocial interventions, Bandawar et al . 2015[ 15 ] reported the superiority of buprenorphine maintenance in treatment retention over other two treatment approaches. For treatment retention, the buprenorphine maintenance was 4.5 times more effective than naltrexone maintenance and seven times more than psychosocial intervention alone.…”

Section: Effectiveness Of Opioid Substitution Therapymentioning

confidence: 99%

Research on opioid substitution therapy in India: A brief, narrative review

Ambekar

Rao

Agrawal

et al. 2018

Indian J Psychiatry

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Opioid dependence is a significant clinical and public health issue in India. Opioid substitution therapy (OST) is the most evidence-based treatment for opioid dependence. Although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far. We conducted a narrative review of Indian research on OST. We conducted an online search for relevant literature in the peer-reviewed journals as well as the general online search for books and monographs. We present the findings of the review in the form of description of literature according to certain identified themes. Considering that methadone has became available in India, only recently, the Indian research on OST predominantly features buprenorphine as the agent. Effectiveness of OST among Indian opioid-dependent patients has been well established through prospective, experimental designs as well as through naturalistic studies using retrospective, chart-review approach. Naturalistic and observational postmarketing surveillance studies have demonstrated the safety of buprenorphine and methadone when used as OST. There are certain areas in which more research on OST will be beneficial for Indian clinicians as well as policy-makers. However, the quantum of evidence base that exists in India is more than adequate to justify the scale-up of this modality of treatment. A conducive policy environment for scaling-up OST is need of the hour.

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Adherence to Buprenorphine Maintenance Treatment in Opioid Dependence Syndrome: A Case Control Study

Cited by 14 publications

References 12 publications

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

Advances in the delivery of buprenorphine for opioid dependence

Research on opioid substitution therapy in India: A brief, narrative review

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