Importance: Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.
Objective: To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.
Design, Setting, And Participants: From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.
Interventions: Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage).
Main Outcomes And Measures: Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).
Results: During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.
Conclusions And Relevance: Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.
Trial Registration: clinicaltrials.gov Identifier: NCT00987961.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811188 | PMC |
| http://dx.doi.org/10.1001/jamainternmed.2014.2556 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Pharmacological Strategies to Decrease Long-Term Prescription Opioid Use: A Systematic Review.
J Clin Med
December 2024
Department of Pharmacy, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
: As long-term prescription opioid use is associated with increased morbidity and mortality, timely dose reduction of prescription opioids should be considered. However, most research has been conducted on patients using heroin. Given the differences between prescription and illicit opioid use, the aim of this review was to provide an overview of pharmacological strategies to reduce prescription opioid use or improve clinical outcomes for people who experience long-term prescription opioid use, including those with opioid use disorder.
View Article and Find Full Text PDFComparative Effectiveness of Buprenorphine/Naloxone and Methadone on Methamphetamine/Amphetamine Use Among People with Opioid Use Disorder in Canada.
Subst Use Addctn J
November 2024
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Article Synopsis
- The study investigates the impact of opioid agonist therapy (OAT) on methamphetamine and amphetamine use among individuals with opioid use disorder (OUD) in Canada, comparing buprenorphine/naloxone and methadone.
- Conducted over 24 weeks, data from a pan-Canadian trial highlighted that both treatments showed no significant effect on reducing methamphetamine/amphetamine use, as assessed through drug testing and self-reporting.
- Despite methamphetamine/amphetamine use being prevalent among participants, results indicated that neither treatment method led to notable changes in their usage patterns throughout the study period.
Initiation of buprenorphine in the emergency department or emergency out-of-hospital setting: A mixed-methods systematic review.
Am J Emerg Med
November 2024
Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia.
Introduction: People who use substances increasingly access healthcare primarily through emergency medical services (EMS) and emergency departments (EDs). To meet the needs of these patients, EMS and EDs have become access points for medications for opioid use disorder (OUD), specifically buprenorphine. This systematic review aimed to quantify the efficacy of these programs, examining retention in treatment for OUD, rates of re-presentation to ED or EMS, and rates of precipitated withdrawal, as well as summarise clinician and patient perspectives on buprenorphine initiation in these settings.
View Article and Find Full Text PDFManagement of opioid use disorder: 2024 update to the national clinical practice guideline.
CMAJ
November 2024
Department of Psychology and Neuroscience (Yakovenko, Belliveau, Fraleigh, Stewart); Department of Psychiatry (Yakovenko, Stewart), Dalhousie University, Halifax, NS; Research Centre of Centre Hospitalier de l'Université de Montréal (Mukaneza, Germé), Montréal, Que.; Department of Medicine (Bach, Wood), University of British Columbia; British Columbia Centre on Substance Use (Bach, Wood), Vancouver, BC; Waypoint Centre for Mental Health Care (Poulin); Department of Psychiatry (Poulin), University of Manitoba, Winnipeg, Man.; Addictions Divisions (Selby), Centre for Addition and Mental Health; Dalla Lana School of Public Health (Selby, Rehm), University of Toronto, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Goyer, Bruneau), Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-del'Île-de Montréal, Montréal, Que.; Division of General Internal Medicine (Brothers), Department of Medicine, Dalhousie University, Halifax, NS; Addiction Medicine Consult Service, Mental Health & Addictions Program (Brothers), Nova Scotia Health; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (Rehm), Toronto, Ont.; Department of Psychology (Hodgins), University of Calgary; Department of Psychology (Hodgins), Alberta Gambling Research Institute, Calgary, Alta.; Drug addiction service (Bruneau), Centre Hospitalier de l'Université de Montréal, Montréal, Que.
Article Synopsis
- - The 2024 update of the 2018 National Guideline for Clinical Management of Opioid Use Disorder emphasizes the need for current scientific evidence to inform treatment practices for opioid use disorder in Canada.
- - A comprehensive review from 2017 to 2023 was conducted to revise the guidelines, involving a national committee including those with personal experience in opioid use disorder, and ensuring quality through established methods.
- - Key changes in the recommendations include recognizing methadone and buprenorphine as equally effective first-line treatments, introducing slow-release oral morphine as a second-line option, and highlighting that psychosocial interventions should be optional rather than mandatory.
Buprenorphine 'microdosing' method for switching patients with opioid dependence from methadone to buprenorphine.
BMJ Case Rep
November 2024
National Drug Dependence Treatment Centre, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India
Various factors limit the acceptability of methadone as an opioid agonist treatment (OAT), in which case, buprenorphine becomes the preferred alternative. The classical approach is to gradually taper methadone to a low dose and buprenorphine is initiated after some opioid-free period, which generally takes weeks. A novel approach known as 'microdosing' or the 'Bernese method' might serve as a valuable alternative.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!