The goal of this meta-analysis is to provide evidence based information about proper dosing for buprenorphine maintenance treatment to improve treatment outcome. To be selected for the review and inclusion in the meta-analysis, articles had to be randomized, controlled, or double-blind clinical trials, with buprenorphine as the study drug; the length of buprenorphine maintenance treatment had to be 3 weeks or longer; doses of buprenorphine had to be clearly stated; outcome measures had to include retention rates in buprenorphine treatment; outcome measures had to include illicit opioid use based on analytical determination of drugs of abuse in urine samples as outcome variables; and outcome measures had to include illicit cocaine use based on analytical determination of drugs of abuse in urine samples as outcome variables. Twenty-nine articles were excluded because they did not meet the inclusion criteria. The authors present the results of 21 articles that met inclusion criteria. The higher buprenorphine dose (16-32 mg per day) predicted better retention in treatment compared with the lower dose (less than 16 mg per day) (P = .009, R(2) adjusted = 0.40), and the positive urine drug screens for opiates predicted dropping out of treatment (P = .019, R(2) Adjusted = 0.40). Retention in treatment predicted less illicit opioid use (P = .033, R(2) Adjusted = 0.36), and the positive urine drug screens for cocaine predicted more illicit opioid use (P = .021, R(2) Adjusted = 0.36). Strong evidence exists based on 21 randomized clinical trials that the higher buprenorphine dose may improve retention in buprenorphine maintenance treatment.
"Of note, just above half of our cohort received daily buprenorphine dosing of ≤16 mg. Given a recent meta-analysis which determined that daily doses of 16–32 mg predicted better retention than lower doses, the implication that even better retention rates could be achieved if higher dosages of buprenorphine are prescribed is intriguing and merits further investigation (Fareed et al., 2012). Two factors were found to be significantly associated with improved retention on buprenorphine at both 6 and 12 months: receiving on-site substance abuse counseling and receiving Table 4 Urine toxicology screening results of 266 opioid-dependent patients on buprenorphine maintenance therapy. "
[Show abstract][Hide abstract] ABSTRACT: Background:
Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs).
Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months.
Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days.
Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.
Drug and alcohol dependence 01/2013; 131(1-2). DOI:10.1016/j.drugalcdep.2012.12.008 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this review the reader will be updated about the most recent
guidelines for treatment of opioid abuse and dependence. The first
phase of treatment which is managing the opioid withdrawal syndrome
and detoxification will be described in details. The opioid agonist
maintenance treatment with either methadone or buprenorphine for
patients who fail abstinent based models will be elaborated. Opioid
antagonists like naltrexone maintenance which are another form of
treatment for patients who do not qualify for or desire opioid agonist
maintenance treatment will also be elaborated. Treatment of special
populations such as adolescents and opioid dependent pregnant
women is included in this review. Psychotherapeutic interventions
will be discussed with emphasis on contingency management (CM)
since it is the most studied intervention in this population. Finally new
approaches for treatment will be mentioned briefly.
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