Effect of Buprenorphine Dose on Treatment Outcome
Emory University, School of Medicine, Atlanta VA Medical Center, Decatur, Georgia 30033, USA. Journal of Addictive Diseases
(Impact Factor: 1.46).
01/2012; 31(1):8-18. DOI: 10.1080/10550887.2011.642758
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.
Available from: Mark K Greenwald
- "A recent meta-analysis (Dunn et al., 2011) of 28 BUP treatment trials that culminated with outpatient dose tapering found that participant retention was modest (median: 65%, range: 4–100%), while urinalysis-verified opioid abstinence was low during maintenance treatment (median: 41%, range: 1–94%), at the end of dose tapering (median: 30%, range: 22–41%), and at a post-taper follow-up assessment (median: 23%, range: 8–52%). Several methodological factors were associated with better outcomes of BUP dose tapering: higher pre-taper BUP maintenance dose (16–32 mg/day vs. <16 mg/day; Fareed et al., 2012), longer BUP maintenance (median: 5 days; range: 0–56; Dunn et al., 2011), longer dose taper (median: 17 days; range: 0–120; Dunn et al., 2011) and opioid-abstinent contingent reinforcement (Amass et al., 1994; Becker et al., 2001; Marsch et al., 2005; Greenwald, 2008). http://dx.doi.org/10.1016/j.drugalcdep.2014.11.016 0376-8716/© 2014 Elsevier Ireland Ltd. "
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ABSTRACT: Buprenorphine (BUP) is effective for treating opioid use disorder. Individuals' heroin-use characteristics may predict their responses to BUP, which could differ during maintenance and dose-taper phases. If so, treatment providers could use pre-treatment characteristics to personalize level of individual care and possibly improve treatment outcomes.
Non-treatment-seeking heroin-dependent volunteers (N=34) initiated outpatient BUP maintenance (8-mg/day) and submitted urine samples thrice weekly tested for opioids (non-contingent result). After completing three programmatically-related inpatient behavioral pharmacology experiments (while maintained on 8-mg/day BUP), participants were discharged and underwent a double-blind BUP dose taper (4-mg/day, 2-mg/day and 0-mg/day during weeks 1-3, respectively) with an opioid-abstinence incentive ($30 per consecutive opioid-negative urine specimen, obtained thrice weekly).
Participants who reported less pre-study (past-month) heroin use and shorter lifetime duration of heroin use were more likely to submit an opioid-negative urine sample during initial outpatient BUP maintenance. Participants who reported more lifetime heroin-quit attempts and provided any opioid-free urine sample during initial outpatient maintenance sustained longer continuous opioid-abstinence during the BUP dose taper. Participants who reported >3 lifetime quit attempts abstained from opioid use nearly one week longer (14 days vs. 8 days to opioid-lapse) and nearly half (46.7%) refrained from opioid use during dose taper.
Number of prior heroin quit attempts may predict BUP dose taper response and provide a metric for stratifying heroin-dependent individuals by relative risk for opioid lapse. This metric may inform personalized relapse prevention care and improve treatment outcomes.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Drug and Alcohol Dependence 11/2014; 146(1). DOI:10.1016/j.drugalcdep.2014.11.016 · 3.42 Impact Factor
Available from: Frederick Altice
- "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. "
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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
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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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