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Initiating buprenorphine treatment for opioid use disorder during short‐term in‐patient ‘detoxification’: a randomized clinical trial
Author(s) -
Stein Michael,
Herman Debra,
Conti Micah,
Anderson Bradley,
Bailey Genie
Publication year - 2020
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14737
Subject(s) - buprenorphine , medicine , opioid use disorder , randomized controlled trial , detoxification (alternative medicine) , opioid , confidence interval , anesthesia , alternative medicine , receptor , pathology
Background and Aims The effectiveness of linking people from short‐term in‐patient managed withdrawal programs (‘detoxification’) to long‐term, primary care‐based buprenorphine is unknown. We tested whether buprenorphine initiation during an opioid withdrawal program and linkage to office‐based buprenorphine (LINK) after discharge would increase engagement with office‐based buprenorphine and decrease illicit opioid use during the ensuing 6 months compared with standard withdrawal management (WM). Design Single‐site randomized controlled trial. Setting Short‐term in‐patient detoxification program in Massachusetts, USA. Participants People with opioid use disorder ( n = 115) who averaged 32.4 years of age, 68.2% male, 79.1% white, using illicit opioids on 27.3 of the last 30 days, were randomly assigned to WM ( n = 59) versus LINK ( n = 56). Intervention and comparator Intervention was buprenorphine induction, in‐patient dose stabilization and post‐discharge transition to maintenance buprenorphine at an affiliated primary care clinic (LINK). Comparator was 5‐day buprenorphine managed withdrawal protocol (WM). Measurements Mean 30‐day rate of use of illicit opioids (primary aim) and prescribed buprenorphine (secondary aim) at 1, 3 and 6 months. Findings Compared with WM, participants in the LINK condition had lower illicit opioid use rates at days 12 [b = −6.81, 95% confidence interval (CI) = –9.69; −3.92, P < 0.001], 35 (b = −8.55, 95% CI – 11.63; −5.47, P < 0.001), 95 (b = −7.34, 95% CI = –10.59; −4.11, P < 0.001) and 185 (b = −3.52, 95% CI = –7.07; 0.27, P = 0.052). The LINK arm had higher prescription buprenorphine use rates ( P < 0.001) at all assessments. Conclusions Among people with opioid use disorder, initiation of, and linkage to, office‐based buprenorphine treatment post‐discharge reduced illicit opioid use and increased days of buprenorphine treatment for up to 6 months post‐discharge compared with an in‐patient detoxification protocol.