Tapering off and returning to buprenorphine maintenance in a primary care Office Based Addiction Treatment (OBAT) program

Weinstein, Zoe; Gryczynski, Gabriela; Cheng, Debbie M.; Quinn, Emily; Hui, David S.; Kim, Hyunjoong W.; LaBelle, Colleen; Samet, Jeffrey H.

doi:10.1016/j.drugalcdep.2018.05.010

Cited by 17 publications

(19 citation statements)

References 31 publications

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“…Typical reasons were “my life has never been this stable—I don’t want to rock the boat,” “I don’t think it will work,” “I’m scared,” and “I’ve tried before and started using again.” While only 16% (n = 45) of the patients attempted buprenorphine taper, the success of this group was remarkable. Their 91% (n = 41) success rate in remaining off of opioids through the end of the study is significantly higher than other reported studies 8,9,26‐28 . This much higher success rate is likely related to allowing the decision to taper to be totally voluntary, as well as the length of taper.…”

Section: Discussionmentioning

confidence: 64%

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Feder

2020

American J Addict

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Background and Objectives There have been few reports of buprenorphine treatment of opioid use disorder in private psychiatric practice. This report describes such a patient population and the outcomes obtained. Methods Chart reviews were performed on 285 patients seen over a 10‐year period in the author’s solo private psychiatric practice. Quantitative and qualitative data were reviewed and analyzed. Results Comorbidity of psychiatric disorders was high (75%), while comorbidity of substance use disorders was low (5%, alcohol only). Fourteen percent of patients completed treatment (tapered off of buprenorphine and remained opioid‐free for up to 7 years). Forty‐eight percent of the sample had good outcomes (remaining on buprenorphine and abstinent of other opioids), 28% had poor outcomes, and 10% dropped out of prolonged successful treatment with unknown final outcomes. The group achieved a relatively high rate of smoking cessation during the study (22%). There were high rates of language disorder (21.6%) and autism spectrum disorder (8.6%) in children of mothers in the study. Discussion and Conclusion Outcomes were excellent compared with those reported in other treatment settings. Rates of smoking cessation were also notable. The treatment of comorbid psychiatric conditions, the setting to develop a strong physician‐patient relationship, patients choosing whether to taper off of buprenorphine, and the slow rate of taper all likely contributed to successful outcomes. Further investigation is needed regarding possible increased rates of developmental disorders in children of mothers treated with buprenorphine. Scientific Significance Private psychiatric practice is a highly successful domain for the treatment of opioid use disorder. (Am J Addict 2020;29:508–514)

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Section: Discussionmentioning

confidence: 64%

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Feder

2020

American J Addict

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“…Only a small minority of individuals in long-term buprenorphine treatment successfully taper off 40 . In contrast, only 15% of our sample was planning to stay on buprenorphine indefinitely, leaving a large group of people taking buprenorphine who will eventually consider and seek support in coming off their medication.…”

Section: Discussionmentioning

confidence: 99%

Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates

et al. 2019

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Background and Objectives: Despite the benefits of maintenance buprenorphine treatment for opioid use disorder (OUD), many individuals report an interest in discontinuing the medication, while also expressing worries about tapering. The purpose of this study was to develop a measure of worries about buprenorphine discontinuation ("Off Bupe") and determine the demographic and clinical characteristics associated with these worries. Methods: Between May 2017 and May 2018, we surveyed adults in an outpatient primary care buprenorphine program (n=138). Reliability and validity of the Off Bupe measure were examined. Results: Participants averaged 39 years of age, 54% were male, average duration of buprenorphine was 189 weeks and 85.5% reported eventually wanting to discontinue buprenorphine, although fewer than 10% were actively tapering. We derived two scales, withdrawal symptom worry (10 items, alpha= .94) and relapse worry (7 items, alpha= .88). Worry about symptoms was positively associated with current buprenorphine dose (p = .016), physical discomfort avoidance (p < .001), and inversely associated with self-efficacy to quit buprenorphine (p < .001) and distress tolerance (p < .001). Worry about opioid relapse was associated positively with age (p = .019), current buprenorphine dose (p = .004), physical discomfort avoidance (p <. 001) and impulsivity (p = .002), and inversely associated with self-efficacy to quit buprenorphine (p < .001). Discussion and Conclusions: Psychometric evaluation of the "Off Bupe" scale demonstrated its content and construct validity, and internal reliability. Scientific Significance: The scale might help individuals with OUD and their providers identify concerns about discontinuing buprenorphine.

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“…4 Providing a safe and anonymous space for users is at the core of Reddit's design and culture, with elaborate community-established rules and etiquettes known as 'rediquette'. 5 Due to the emphasis on anonymity of this platform, it is particularly popular for openly discussing sensitive and stigmatized topics, such as opioid addiction and recovery.…”

Section: Data Collection Strategies For Initial Analysesmentioning

confidence: 99%

“…One study looked at 28-day vs 56-day tapering schedule in adolescents with OUD and found more opioid-free urines and more sustained retention in treatment with the longer tapering regimen (4). Another 12-year retrospective study of 1308 patients on buprenorphine showed that an estimated 15% tapered off buprenorphine, fewer than half of whom were medically supervised (5). Package insert information for the commonly used sublingual buprenorphine formulations do not include tapering advice and, in fact, may specifically advise against cutting, chewing, or swallowing the strips, all methods that patients structuring their own buprenorphine tapers commonly use (6).…”

Section: Introductionmentioning

confidence: 99%

Effective buprenorphine use and tapering strategies: Endorsements and insights by people in recovery from opioid use disorder on a Reddit forum

Graves

Sarker

Al-Garadi

et al. 2019

Preprint

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Opioid use disorder (OUD) is a national crisis in the United States and buprenorphine is one of the most effective evidence-based treatments. However, few studies have explored successful strategies for using and tapering buprenorphine to achieve stable recovery, particularly due to the difficulties of conducting long-term studies involving patients with OUD. In this study, we show that discussions on the anonymous social network Reddit may be leveraged, via automatic text mining methods, to discover successful buprenorphine use and tapering strategies. We discovered that longer tapering schedules, compared to those investigated in past clinical trials, may lead to (self-reported) sustained recovery. Furthermore, Reddit posts also provide key information regarding buprenorphine withdrawal, cravings, adjunct medications for withdrawal symptoms and relapse prevention strategies. AbstractOpioid use disorder (OUD) is a public health emergency in the United States. Over 47,000 overdose-related deaths in 2017 involved opioids. Medication-assisted treatment (MAT), in particular, buprenorphine and buprenorphine combination products such as Suboxone®, is the most effective, evidence-based treatment for OUD. However, there are a limited number of conclusive scientific studies that provide guidance to medical professionals about strategies for using buprenorphine to achieve stable recovery. In this study, we used data-driven natural language processing methods to mine a total of 16,146 posts about buprenorphine from 1933 unique users on the anonymous social network Reddit. Analysis of a sample of these posts showed that 74% of the posts described users' personal experiences and that the top three topics included advice on using Suboxone® (55.0%), Suboxone® dosage information (35.5%) and information about Suboxone® tapering (32.0%). Based on two models, one that incorporated 'upvoting' by other members and one that did not, we found that Reddit users reported more successful recovery with longer tapering schedules, particularly from 2.0 mg to 0.0 mg (median: 93 days; mean: 95 days), as compared to shorter tapering schedules investigated in past clinical trials. Diarrhea, insomnia, restlessness, and fatigue were commonly reported adverse events. Physical exercise, clonidine, and Imodium® were frequently reported to help during the recovery process. Due to the difficulties of conducting longer-term clinical trials involving patients with OUD, clinicians should consider other information sources including peer discussions from the abundant, real-time information available on Reddit.

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Tapering off and returning to buprenorphine maintenance in a primary care Office Based Addiction Treatment (OBAT) program

Cited by 17 publications

References 31 publications

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates

Effective buprenorphine use and tapering strategies: Endorsements and insights by people in recovery from opioid use disorder on a Reddit forum

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