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Addiction. 2019 Aug 20. doi: 10.1111/add.14737. [Epub ahead of print]

Initiating buprenorphine treatment for opioid use disorder during short-term in-patient 'detoxification': a randomized clinical trial.

Author information

1
Boston University School of Public Health, Boston, MA, USA.
2
Department of General Medicine and Addictions Research, Butler Hospital, Providence, RI, USA.
3
Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.

Abstract

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.

KEYWORDS:

Aftercare; buprenorphine; detoxification; opioids; primary care; randomized trial

PMID:
31430414
DOI:
10.1111/add.14737

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