Home Buprenorphine/Naloxone Induction in Primary Care

• Published in: Journal of general internal medicine : JGIM Vol. 24; no. 2; pp. 226 - 232
• Main Authors: Lee, Joshua D., Grossman, Ellie, DiRocco, Danae, Gourevitch, Marc N.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2009; Springer; Springer Nature B.V
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Ambulatory Care - methods; Ambulatory Care - standards; Ambulatory Care - trends; Biological and medical sciences; Buprenorphine - administration & dosage; Drug addiction; Drug therapy; Female; Follow-Up Studies; General aspects; Home health care; Home Nursing - methods; Home Nursing - standards; Home Nursing - trends; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Naloxone - administration & dosage; Narcotics; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - psychology; Original; Original Article; Primary care; Primary Health Care - methods; Primary Health Care - standards; Primary Health Care - trends; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Substance abuse treatment; Methadone Maintenance; Opioid Dependence; Buprenorphine; Prescription Opioid; Opioid Withdrawal; Morphinan derivatives; Medicine; Narcotic antagonist; Drug addiction; Naloxone; Poison withdrawal; Induction; Primary health care; Opiates; Narcotic analgesic
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-008-0866-8

ABSTRACT BACKGROUND Buprenorphine can be used for the treatment of opioid dependence in primary care settings. National guidelines recommend directly observed initial dosing followed by multiple in-clinic visits during the induction week. We offered buprenorphine treatment at a public hospital primary care clinic using a home, unobserved induction protocol. METHODS Participants were opioid-dependent adults eligible for office-based buprenorphine treatment. The initial physician visit included assessment, education, induction telephone support instructions, an illustrated home induction pamphlet, and a 1-week buprenorphine/naloxone prescription. Patients initiated dosing off-site at a later time. Follow-up with urine toxicology testing occurred at day 7 and thereafter at varying intervals. Primary outcomes were treatment status at week 1 and induction-related events: severe precipitated withdrawal, other buprenorphine-prompted withdrawal symptoms, prolonged unrelieved withdrawal, and serious adverse events (SAEs). RESULTS Patients (N = 103) were predominantly heroin users (68%), but also prescription opioid misusers (18%) and methadone maintenance patients (14%). At the end of week 1, 73% were retained, 17% provided induction data but did not return to the clinic, and 11% were lost to follow-up with no induction data available. No cases of severe precipitated withdrawal and no SAEs were observed. Five cases (5%) of mild-to-moderate buprenorphine-prompted withdrawal and eight cases of prolonged unrelieved withdrawal symptoms (8% overall, 21% of methadone-to-buprenorphine inductions) were reported. Buprenorphine-prompted withdrawal and prolonged unrelieved withdrawal symptoms were not associated with treatment status at week 1. CONCLUSIONS Home buprenorphine induction was feasible and appeared safe. Induction complications occurred at expected rates and were not associated with short-term treatment drop-out.