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Home Buprenorphine/Naloxone Induction in Primary Care

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ABSTRACT

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.

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Acknowledgments

The authors wish to thank Drs. Andrew B. Wallach and Valerie D. Perel and the staff of the Bellevue Adult Primary Care Clinic, and Drs. Stephen Ross, John Rotrosen, Sapana Shah and Andrea Truncali for their advice and support. Funding: This study was supported in part by a grant from the New York City Department of Health and Mental Hygiene and the New York City Health and Hospitals Corporation.

Conflict of Interest

None disclosed. Drs. Lee and Gourevitch receive research funding from Cephalon, Inc., and Alkermes, Inc., to support studies of alcohol treatment.

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Authors and Affiliations

  1. New York University School of Medicine, New York, NY, USA

    Joshua D. Lee MD MSc, Ellie Grossman MD MPH, Danae DiRocco MPH & Marc N. Gourevitch MD MPH

  2. 423 E. 23rd St., VAMC 15th Floor, 15156 North, New York, NY, 10010, USA

    Joshua D. Lee MD MSc

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  1. Joshua D. Lee MD MSc
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  2. Ellie Grossman MD MPH
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  3. Danae DiRocco MPH
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  4. Marc N. Gourevitch MD MPH
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Corresponding author

Correspondence to Joshua D. Lee MD MSc.

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Online Appendix

“Burpenorphine – Beginning Treatment” (please see attached PDF) (PDF 544 KB)

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Lee, J.D., Grossman, E., DiRocco, D. et al. Home Buprenorphine/Naloxone Induction in Primary Care. J GEN INTERN MED 24, 226–232 (2009). https://doi.org/10.1007/s11606-008-0866-8

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  • DOI: https://doi.org/10.1007/s11606-008-0866-8

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