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Buprenorphine for Opioid Dependence Is Feasible in Primary Care

Monitoring and medication prescription by generalist nurses and physicians works for many patients.

Buprenorphine plus counseling is efficacious for treating opioid dependence. But questions remain about the feasibility of this combination in primary care settings.

Researchers at Yale randomized 166 patients with opioid dependence who received daily maintenance buprenorphine (mean dose, 17.5 mg in a combination tablet with naloxone) to one of three levels of therapy:

• once-weekly medication dispensing plus 20 minutes of counseling
  
• thrice-weekly medication dispensing plus 20 minutes of counseling
  
• thrice-weekly medication dispensing plus 45 minutes of counseling
  

Counseling sessions (administered by primary care nurses) occurred regularly for 24 weeks and addressed drug use, efforts to abstain, self-help, and results of weekly urine tests. All patients met with physicians for 20 minutes each month.

No differences in opioid use were found between groups. Self-reported opioid use decreased from a weekly mean of 5.3 days before treatment to 0.4 days during treatment. About 40% of all weekly urine specimens were negative for opioids, and 39%–48% of subjects in each group completed 24 weeks of treatment. Patient satisfaction was significantly better in the once-weekly group than in the thrice-weekly groups.

Comment: These results suggest that opioid dependence can be treated in primary care settings with an approach (nurse and physician monitoring, medication prescription) that is similar to those used to manage other chronic illnesses. As with other therapies for chronic illnesses, improving adherence to long-term treatment is vital.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine August 15, 2006

Citation(s):

Fiellin DA et al. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med 2006 Jul 27; 355:365-74.

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