Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings

• Published in: Annals of family medicine 2007-03, Vol.5 (2), p.146-150
• Main Authors: Mintzer, Ira L, Eisenberg, Mark, Terra, Maria, MacVane, Casey, Himmelstein, David U, Woolhandler, Steffie
• Format: Article
• Language: English
• Subjects: Adult; Buprenorphine - therapeutic use; Community Health Services - methods; Drug Combinations; Female; Humans; Insurance, Health; Male; Massachusetts; Middle Aged; Multivariate Analysis; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Opioid-Related Disorders - drug therapy; Original Research; Outpatient Clinics, Hospital; Primary Health Care - methods; Self-Help Groups; Treatment Outcome
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.665

Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in non-research clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings. We studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use. Fifty-four percent of patients were sober at 6 months. There was no significant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings. Opioid-addicted patients can be safely and effectively treated in non-research primary care settings with limited on-site resources. Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings.