Improved quality of life, clinical, and psychosocial outcomes among heroin-dependent patients on ambulatory buprenorphine maintenance.

Mental Health Services, Ministry of Health, Jerusalem, Israel.
Substance Use &amp Misuse (Impact Factor: 1.11). 01/2010; 45(1-2):288-313. DOI: 10.3109/10826080902873010
Source: PubMed

ABSTRACT A prospective longitudinal design was employed to examine the effects of buprenorphine maintenance on quality of life (QOL), clinical, and psychosocial characteristics of heroin-dependent patients.
Between 2003 and 2005 data were collected on 259 patients attending the outpatient centers for treatment of drug addictions across Israel, of which 157 were reevaluated 16 weeks later and 105 reevaluated 32 weeks later using the Clinical Global Impression, Distress Scale for Adverse Symptoms, Quality of Life Enjoyment and Satisfaction Questionnaire, General Health Questionnaire, General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Univariate and multivariate analyses were conducted to examine the association between the parameters and the cross-sectional and longitudinal predictions of the QOL outcomes.
The groups did not differ in baseline values and their post-treatment ratings revealed significant improvement on virtually all the scales. Perceived self-efficacy and social support from friends and significant others at baseline as well as their changes over time were the best predictors of the QOL in the short and long terms. The study's limitations are noted.
The beneficial effects on the QOL were associated with improvement in the psychosocial parameters and a reduction in buprenorphine-related side effects and psychological distress. This study could stimulate research to compare the QOL related to buprenorphine and methadone treatment and serve as a basis on which a controlled study should be performed.

  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigated drug substitution patients' biographical data for counselling, to recognize social and other risk factors and additionally consumed drugs. We decided on a retrospective, descriptive investigation in one practice. A preformed pattern of questions was applied to the charts of drug-substituted patients. We found data on 332 men and 114 women. Statistical connections were counted by SPSS 11.5 and Chi-square-tests. Two-thirds had completed compulsory school, one third had some kind of vocational training, and current occupation was frequently different to training. 72% of the patients claimed to have "a supportive family relationship with their families". 25% were in touch with their children. Drug abuse started early, below the age of 14 for nearly 25% of our group.179 patients had withdrawal treatment.138 patients (31%) confirmed hepatitis C infection, 23 out of 441 had tested HIV positive (5.2%). Inconstant relationships to family, education and profession combine to early drug use.
    Wiener Medizinische Wochenschrift 01/2012; 162(1-2):39-43.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Buprenorphine, a partial μ-opioid receptor agonist and κ-opioid receptor antagonist, is an effective analgesic. The effects of buprenorphine on sleep have not been well characterized. This study tested the hypothesis that an antinociceptive dose of buprenorphine decreases sleep and decreases adenosine concentrations in regions of the basal forebrain and pontine brainstem that regulate sleep. Male Sprague Dawley rats were implanted with intravenous catheters and electrodes for recording states of wakefulness and sleep. Buprenorphine (1 mg/kg) was administered systemically via an indwelling catheter and sleep-wake states were recorded for 24 h. In additional rats, buprenorphine was delivered by microdialysis to the pontine reticular formation and substantia innominata of the basal forebrain while adenosine was simultaneously measured. An antinociceptive dose of buprenorphine caused a significant increase in wakefulness (25.2%) and a decrease in nonrapid eye movement sleep (-22.1%) and rapid eye movement sleep (-3.1%). Buprenorphine also increased electroencephalographic delta power during nonrapid eye movement sleep. Coadministration of the sedative-hypnotic eszopiclone diminished the buprenorphine-induced decrease in sleep. Dialysis delivery of buprenorphine significantly decreased adenosine concentrations in the pontine reticular formation (-14.6%) and substantia innominata (-36.7%). Intravenous administration of buprenorphine significantly decreased (-20%) adenosine in the substantia innominata. Buprenorphine significantly increased time spent awake, decreased nonrapid eye movement sleep, and increased latency to sleep onset. These disruptions in sleep architecture were mitigated by coadministration of the nonbenzodiazepine sedative-hypnotic eszopiclone. The buprenorphine-induced decrease in adenosine concentrations in basal forebrain and pontine reticular formation is consistent with the interpretation that decreasing adenosine in sleep-regulating brain regions is one mechanism by which opioids disrupt sleep.
    Anesthesiology 08/2011; 115(4):743-53. · 5.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Background: Physician acceptance of cash payment and low adherence to practice guidelines may contribute to buprenorphine-naloxone diversion. The purpose of this study was to investigate the clinical practice policies of physicians who provide office-based treatment for opioid dependence with buprenorphine-naloxone. Methods: Data were obtained from 31 of 71 practices surveyed (response rate 43.7%) that provided answers to at least some of the survey questions. Results: Of these practices, 28 (90.3%) accepted cash as payment and 6 (19.4%) accepted only cash for treatment services. Analysis of open-ended responses to questions about office policies revealed wide variation among practices and overall suboptimal adherence to recommended treatment guidelines. Conclusions: These results underscore the need for continuing education for physicians who prescribe buprenorphine-naloxone.
    Substance Abuse 01/2012; 34(2):105-7. · 1.25 Impact Factor


Available from
May 20, 2014