Buprenorphine Outpatient Outcomes Project: can Suboxone be a viable outpatient option for heroin addiction?

Abstract

BackgroundOpioid dependence treatment traditionally involves methadone clinics, for which dispensing schedules can be cumbersome. Buprenorphine, a partial agonist of the mu receptor and antagonist of the kappa receptor, is a potential outpatient alternative to methadone. Funded by a grant from the State of Maryland's Community Health Resources Commission (CHRC), the Buprenorphine Outpatient Outcomes Project (BOOP) evaluates the outcome of Suboxone (buprenorphine/naloxone) treatment on abstinence from heroin use, rates of emergency room visits and hospitalizations, legal issues, and quality of life.MethodsActive heroin users were recruited between June 2007 and June 2010 and induction therapy with Suboxone was instituted during hospitalization. Once discharged, patients were followed as outpatients for maintenance treatment and counseling. Data were collected from electronic medical records, Maryland state legal records, and SF-36® Health Surveys regarding several parameters and patients were categorized according to duration of treatment with Suboxone into one of three groups: <1 month, 1–3 months, and >3 months.ResultsA total of 220 participants were included in the study. The age range of participants was 18–67 years with most being African American males. Eighty-three (38%) remained in the study for at least 1 month, with 37 of the 83 (45%) remaining in treatment for >3 months. Ten of the 37 (27%) never relapsed after their longest period of abstinence from heroin. During the first year after initiating treatment with Suboxone, hospitalization and emergency room visit rates for all 220 participants decreased by 45 and 23%, respectively, as compared to the year prior to starting treatment. The number of legal charges for drug possession decreased from 70 to 62. Anecdotally, the quality of life seemed to improve in those who were treated with Suboxone for longer periods of time and received regular counseling.ConclusionOverall, Suboxone is an effective treatment method for heroin addiction and is a viable outpatient therapy option. Individualized treatment plans and counseling must be implemented for maximum benefits to be seen. Retention of patients for a long duration of therapy was difficult, but for those who did remain, benefits were seen in overall health, abstinence from heroin use, cognition, and quality of life.

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

“…But most importantly, it helps put people on the path to recovery and enhances their quality of life [46,47]. We are in the midst of an epidemic that is targeting teens and young adults, and we are losing this battle with a disease that is taking the lives of 46 individuals daily [48].…”

Medication‐assisted treatment for hospitalized patients with intravenous‐drug‐use related infective endocarditis

“…Prior research suggests initiation of MAT in the hospital or emergency room setting facilitates entry into treatment following discharge . However, research on the use of MAT for hospitalized IDU‐IE patients is limited.…”

Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization

“…Observational studies have examined the feasibility of linking these highly vulnerable patients to outpatient treatment (Aszalos, McDuff Weintraub, Montoya, & Schwartz, 1999; Shanahan, Beers, Alford, Brigandi, & Samet, 2010; Sittambalam, Vij, & Ferguson, 2014; Suzuki et al, 2015) and measured their long term retention (Caldiero, Parran, Adelman, & Piche, 2006). However, these studies did not evaluate whether in-hospital induction, stabilization, and linkage to outpatient treatment actually reduced opioid use.…”