LAS VEGAS, NV— As a first-line option, buprenorphine/naloxone can plausibly be given for opioid dependency through a primary care setting before attempting residential or intensive counseling, according to a study presented at PAINWeek 2012.
National guidelines advocate “in house induction” followed by multiple clinic visits with counseling. The aforementioned “in house induction” has been shown to be a hindrance to buprenorphine/naloxone treatment. Additionally, the optimum number of office visits and degree of counseling in an outpatient primary care setting has not been determined.
A study conducted by Tommy Swate, MD, from Houston, TX, sought to identify patient retention rates at 90 days using standard outpatient medical office visits with a home unobserved induction protocol at 30, 60, and 90 days. The trial enrolled 166 patients, either classified as opioid-dependent or diagnosed with chronic pain syndrome. The initial physician visit included assessment, education, and a 30-day buprenorphine prescription; patients started receiving doses of treatment off premises at a subsequent time. The primary outcome of the trial was treatment status at 90 days. An effort was made to try to reach patients discontinuing the trial to establish the cause of discontinuation.
A total of 27 out of 52 opioid-dependent patients (52%) and 21 out of 27 chronic pain syndrome patients (78%) remained in treatment after 90 days. All patients in the trial at the 90-day mark received urine screens for opioid and buprenorphine/naloxone. Of the opioid-dependent patients discontinuing the trial, 20 did not return for the second visit while 11 did not return for the third visit. For chronic pain syndrome patients, 25 did not return for the second visit while 10 did not return for the third visit.
Fifteen of the patients discontinuing the program cited economic or transportation difficulties as the reason for not revisiting the office for therapy.
The dropout rate of opioid-dependent patients receiving buprenorphine/naloxone through outpatient therapy with home induction and follow-up at 30, 60, and 90 days were in line with discontinuation rates with more intensive and extended treatment. Dr. Swate further noted that program assessment is essential for numerous reasons, including accountability. Furthermore, outcome evaluation is necessary to establish the most efficacious and cost-conscious approaches to therapy.