Buprenorphine-Naloxone May Effectively Treat Opioid Addiction

In a nonresearch primary care setting, opioid-addicted patients can be effectively treated with buprenorphine-naloxone, according to the results of a study reported in the March/April issue of the Annals of Family Medicine.
"Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002," write Ira L. Mintzer, MD, from the Harvard Medical School/Cambridge Health Alliance in Cambridge, Massachusetts, and colleagues. "Efficacy of this treatment in nonresearch clinical settings has not been studied.... Opiate-agonist pharmacotherapy has been shown to decrease illicit opiate use."
The investigators studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment of opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic and a primary care practice in a free-standing neighborhood health center. The main endpoint was sobriety at 6 months as determined by the treating clinician based on periodic urine drug tests, frequent physical examinations, and questioning the patients about substance use.
At 6 months, 54% of patients were sober. These success rates, which range from 50% to 60%, were similar to those reported from more specialized treatment centers using methadone or L-alpha-acetylmethadol.
Site of care, drug of choice, neighborhood poverty level, and dose of buprenorphine-naloxone were not significant predictors of sobriety. However, sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.
There was 1 adverse patient event: an unexpected cardiac death. Because of the small sample size and the lack of a control group, it could not be determined whether buprenorphine treatment caused this death.
"Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources," the authors write. "Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings."