Within-subject evaluation of interim buprenorphine treatment during waitlist delays

• Published in: Drug and alcohol dependence Vol. 220; p. 108532
• Main Authors: Oleskowicz, Tatum N., Ochalek, Taylor A., Peck, Kelly R., Badger, Gary J., Sigmon, Stacey C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.03.2021; Elsevier Science Ltd
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Anxiety; Buprenorphine; Buprenorphine - therapeutic use; Clinical outcomes; Computerization; Depression; Drug abuse; Drug addiction; Drug administration; Drugs; Efficacy; Evaluation; Health status; Hepatitis; Hepatitis C; HIV; Human immunodeficiency virus; Humans; Interactive voice response; Interim treatment; Male; Mental health; Narcotic Antagonists - therapeutic use; Narcotics; Opiate Substitution Treatment - methods; Opiate Substitution Treatment - psychology; Opioid agonist treatment; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioids; Pilot Projects; Psychosocial factors; Psychosocial functioning; Risk behavior; Risk taking; Rural areas; Rural communities; Social interactions; Substance abuse treatment; Substance use disorder; Technology; Waiting Lists; Young Adult; Hepatitis; Buprenorphine; HIV; Opioid agonist treatment; Depression; Anxiety; Opioid use disorder; Interim treatment
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2021.108532

•Delays to opioid treatment are common, particularly in rural geographic areas.•Interim buprenorphine has been shown to reduce illicit opioid use during treatment delays.•Interim buprenorphine treatment may also reduce depression, anxiety and overdose risk.•Interim dosing should be considered when delays to comprehensive treatment exist. The effectiveness of opioid agonist treatment for opioid use disorder (OUD) is well established, and delays to treatment are still common, particularly in rural geographic areas. In a randomized 12-week pilot study, we demonstrated initial efficacy of a technology-assisted Interim Buprenorphine Treatment (IBT) vs. continued waitlist control (WLC) for reducing illicit opioid use and other risk behaviors during waitlist delays. Upon completion of that parent trial, WLC participants were given the opportunity to receive 12 weeks of IBT, permitting an additional within-subject examination of IBT effects. Sixteen WLC participants crossed over to receive IBT, involving buprenorphine maintenance with bi-monthly visits, medication administration at home via a computerized device, daily monitoring calls using an Interactive Voice Response (IVR) phone system, and IVR-generated random call-backs. Biochemically-verified illicit opioid abstinence, changes in psychosocial functioning, and HIV + HCV knowledge were examined among participants originally randomized to the WLC phase and who subsequently crossed over to IBT (IBTc). Participants submitted a higher percentage of illicit opioid negative specimens at Weeks 4, 8, and 12 during IBT (75 %, 63 %, and 50 %) vs. WLC (0%, 0%, and 0%), respectively (p’s<.01). Participants also demonstrated improvements in anxiety, depression, and HIV and HCV knowledge (p’s<.01). Medication administration, daily IVR call and random call-back adherence and treatment satisfaction were also favorable. This within-subject evaluation provides additional support for interim buprenorphine’s efficacy in reducing illicit opioid use and improving health outcomes during waitlist delays for more comprehensive treatment.