Comparison of Buprenorphine Treatment for Opioid Dependence in 3 Settings

Abstract

Although use of buprenorphine in the treatment of opioid dependence is expected to continue to increase, little is known about the optimal setting for providing the medical and psychosocial care required with buprenorphine pharmacotherapy. OBJECTIVE This study compared buprenorphine therapy delivered in three distinct treatment settings: an opioid-treatment program (OTP) offering individual counseling; a group counseling program utilizing the manualized Matrix Model (MMM) of cognitive-behavioral treatment; and a private clinic setting mirroring standard medical management for buprenorphine treatment provided specifically at a psychiatrist’s private practice (PCS). METHOD Participants were inducted on buprenorphine and provided with treatment over a 52-week study duration. All participants were scheduled for weekly treatment visits for the first 6 study weeks, and two sites reduced treatment to monthly visits for dispensing of medication and psychosocial counseling. Outcomes include opioid use, participant retention in treatment, and treatment participation. RESULTS Participants presenting for treatment at the sites differed only by race/ethnicity, and opioid use did not differ by site. Retention differed by treatment site, with the number of participants who stayed in the study until the end of 20 weeks significantly associated with treatment site. The mean number of minutes spent in each individual counseling session also differed by site. Although no difference in opioid use by treatment site was found, results document a significant association between opioid use and buprenorphine dose. DISCUSSION These results show some differences by treatment site, although the similarity and relative ease in which the sites were able to recruit participants for treatment with buprenorphine, and minor implementation problems reported suggests the feasibility of treatment with buprenorphine across various treatment settings. CONCLUSION Similar rates of continued opioid use across study sites and few qualitative reports of problems indicates that treatment with buprenorphine and associated psychosocial counseling are safe and relatively easy to implement in a variety of treatment settings.

Barriers to Medical Provider Support for Prescription Naloxone As Overdose Antidote for Lay Responders

“…Support from these providers is critical for expanding naloxone distribution to at-risk populations, who may not have any other point of contact for overdose prevention education or naloxone prescription. Previous work indicates that buprenorphine/naloxone treatment for opioid dependence is safe, feasible, and cost effective (Mintzer et al, 2007;Miotto et al, 2012;(Raisch, Fye, Boardman, & Sather, 2002;Schackman, Leff, Polsky, Moore, & Fiellin, 2012), with demonstrated capacity of prescribers to address addiction in the primary care setting. Incorporating overdose training and response into the medication assisted therapy conversation can build on these prior successes.…”

The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review

“…Miotto and colleagues (43) randomized 94 opioid- dependent individuals to one of three treatment sites in which they received buprenorphine maintenance treatment over a 52-week period: (1) an opioid treatment program that provided supportive counseling by a certified counselor at the time of the medication visit (weekly during weeks 1–6 and monthly during weeks 7–52), (2) a primary care setting in which a physician provided brief counseling at the time of the study visits (also weekly during weeks 1–6 and monthly during weeks 7–52), or (3) behaviorally-oriented psychosocial treatment using the Matrix Model, in which cognitive-behavioral therapy groups were offered weekly for weeks 1–52. At week 20, there were significant differences by setting in terms of retention (21% in the opioid treatment program, 33% in the primary care setting, and 51% in the Matrix Model, p =.05).…”

A randomized controlled trial of prison-initiated buprenorphine: Prison outcomes and community treatment entry

“…The buprenorphine/naloxone combination lowers the likelihood of intravenous abuse because injected naloxone can precipitate opioid withdrawal (Tompkins and Strain, 2011). Buprenorphine has been safely and effectively implemented in various community settings: opioid treatment programs, non-methadone outpatient programs, community health centers, and medical practices (Miotto et al, 2012; Mitchell et al, 2012). In community settings, it has been effective in reducing heroin use and retaining patients in treatment (Alford et al, 2011; Mattick et al, 2009; Miotto et al, 2012; Mitchell et al, 2012).…”