Home buprenorphine/naloxone induction in primary care

Joshua Lee, Ellie Grossman, Danae Dirocco, Marc Gourevitch

Research output: Contribution to journalArticle

Abstract

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. 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). 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. Home buprenorphine induction was feasible and appeared safe. Induction complications occurred at expected rates and were not associated with short-term treatment drop-out.

Original languageEnglish (US)
Pages (from-to)226-232
Number of pages7
JournalJournal of General Internal Medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 2009

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Buprenorphine
Primary Health Care
Substance Withdrawal Syndrome
Opioid Analgesics
Methadone
Prescriptions
Therapeutics
Pamphlets
Naloxone Drug Combination Buprenorphine
Public Hospitals
Lost to Follow-Up
Heroin
Ambulatory Care
Telephone
Toxicology
Urine
Guidelines
Physicians
Education

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Home buprenorphine/naloxone induction in primary care. / Lee, Joshua; Grossman, Ellie; Dirocco, Danae; Gourevitch, Marc.

In: Journal of General Internal Medicine, Vol. 24, No. 2, 02.2009, p. 226-232.

Research output: Contribution to journalArticle

Lee, Joshua ; Grossman, Ellie ; Dirocco, Danae ; Gourevitch, Marc. / Home buprenorphine/naloxone induction in primary care. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 2. pp. 226-232.
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