Document Detail

Home buprenorphine/naloxone induction in primary care.
MedLine Citation:
PMID:  19089508     Owner:  NLM     Status:  MEDLINE    
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.
Joshua D Lee; Ellie Grossman; Danae DiRocco; Marc N Gourevitch
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2008-12-17
Journal Detail:
Title:  Journal of general internal medicine     Volume:  24     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-21     Completed Date:  2009-11-10     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  226-32     Citation Subset:  IM    
New York University School of Medicine, New York, NY, USA.
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MeSH Terms
Ambulatory Care / methods,  standards,  trends
Buprenorphine / administration & dosage*
Follow-Up Studies
Home Nursing / methods*,  standards,  trends
Middle Aged
Naloxone / administration & dosage*
Opioid-Related Disorders / drug therapy,  psychology
Primary Health Care / methods*,  standards,  trends
Reg. No./Substance:
465-65-6/Naloxone; 52485-79-7/Buprenorphine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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