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Use of buprenorphine in opioid-dependence interventions may increase positive outcomes

Opioid-dependent patients who received buprenorphine as part of an opioid-dependence intervention were more likely to engage in addiction treatment and less likely to use opioids, according to study findings in JAMA.

Gail D’Onofrio, MD, MS, of the Yale School of Medicine, and colleagues conducted a randomized trial to test the efficacy of three interventions for opioid dependence among 329 opioid-dependent patients who were treated in the ED between April 2009 and June 2013.

Gail D'Onofrio

After initial screening, patients were randomly assigned to either receive referral to treatment (n = 104); a brief intervention and facilitated referral to community-based treatment services (n = 111); or a brief intervention, ED-initiated treatment with buprenorphine/naloxone and referral to primary care for continued buprenorphine treatment (n = 114).

“Prior research at Yale has demonstrated that buprenorphine treatment is highly effective in primary care, and this study was designed in part to expand the reach of this treatment to this critical ED patient population,” study researcher Patrick O’Connor, MD, MPH, of the Yale School of Medicine, said in a press release.

Study findings indicated that 30 days after randomization, 78% of patients in the buprenorphine treatment group engaged in addiction treatment, compared with 37% of those in the referral group and 45% in the brief intervention group (P < .001).

Patrick O'Connor

The number of days of illicit opioid use per week decreased from 5.4 days to 0.9 days among patients in the buprenorphine group, compared with 5.4 to 2.3 days among patients in the referral group and 5.6 to 2.4 days among patients in the brief intervention group (P < .001).

Risk for HIV did not significantly differ among treatment groups (P = .66).

Thirty-seven percent of patients in the referral group used inpatient addiction treatment services, compared with 35% of patients in the brief intervention group and 11% of the buprenorphine group (P < .001).

“[Patients in the buprenorphine group] had better results and less utilization of resources,” study researcher David A. Fiellin, MD, said in the release.

While the study findings are promising for future drug-dependence interventions, they require further research in other EDs, according to researchers.

“Effectively linking ED-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care,” O’Connor said in the release. – by Amanda Oldt

Disclosure: D’Onofrio reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.