Factors Associated with Complicated Buprenorphine Inductions

Overview

Journal J Subst Abuse Treat

Specialty Psychiatry

Date 2010 Aug 5

PMID 20682186

Citations 40

Authors

Susan D Whitley

Nancy L Sohler

Hillary V Kunins

Angela Giovanniello

Xuan Li

Galit Sacajiu

Chinazo O Cunningham

Affiliations

Soon will be listed here.

Abstract

Despite data supporting its efficacy, barriers to implementation of buprenorphine for office-based treatment are present. Complications can occur during buprenorphine inductions, yet few published studies have examined this phase of treatment. To examine factors associated with complications during buprenorphine induction, we conducted a retrospective chart review of the first 107 patients receiving buprenorphine treatment in an urban community health center. The primary outcome, defined as complicated induction (precipitated or protracted withdrawal), was observed in 18 (16.8%) patients. Complicated inductions were associated with poorer treatment retention (than routine inductions) and decreased over time. Factors independently associated with complicated inductions included recent use of prescribed methadone, recent benzodiazepine use, no prior experience with buprenorphine, and a low initial dose of buprenorphine/naloxone. Findings from this study and further investigation of patient characteristics and treatment characteristics associated with complicated inductions can help guide buprenorphine treatment strategies.

Citing Articles

Prescription psychostimulant use, admissions and treatment initiation and retention in pregnant people with opioid use disorder.

Xu K, Berkel T, Martin C, Jones H, Carter E, Kelly J Nat Ment Health. 2024; 2(7):801-808.

PMID: 39726823 PMC: 11671152. DOI: 10.1038/s44220-024-00270-w.

Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl.

Thakrar A, Christine P, Siaw-Asamoah A, Spadaro A, Faude S, Snider C JAMA Netw Open. 2024; 7(9):e2435895.

PMID: 39331392 PMC: 11437388. DOI: 10.1001/jamanetworkopen.2024.35895.

Patient experiences of buprenorphine dispensing from a mobile medical unit.

Messmer S, Elmes A, Infante A, Patterson A, Smith M, Murphy A Addict Sci Clin Pract. 2024; 19(1):53.

PMID: 39026326 PMC: 11264859. DOI: 10.1186/s13722-024-00484-4.

Managing Opioid Withdrawal Symptoms During the Fentanyl Crisis: A Review.

Weber A, Trebach J, Brenner M, Thomas M, Bormann N Subst Abuse Rehabil. 2024; 15:59-71.

PMID: 38623317 PMC: 11016949. DOI: 10.2147/SAR.S433358.

Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.

Jones B, Geier M, Neuhaus J, Coffin P, Snyder H, Soran C Harm Reduct J. 2024; 21(1):80.

PMID: 38594721 PMC: 11005253. DOI: 10.1186/s12954-024-00998-9.

References

Wesson D, Ling W . The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003; 35(2):253-9. DOI: 10.1080/02791072.2003.10400007. View

Walley A, Alperen J, Cheng D, Botticelli M, Castro-Donlan C, Samet J . Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008; 23(9):1393-8. PMC: 2518016. DOI: 10.1007/s11606-008-0686-x. View

Fiellin D . The first three years of buprenorphine in the United States: experience to date and future directions. J Addict Med. 2011; 1(2):62-7. DOI: 10.1097/ADM.0b013e3180473c11. View

Lavie E, Fatseas M, Denis C, Auriacombe M . Benzodiazepine use among opiate-dependent subjects in buprenorphine maintenance treatment: correlates of use, abuse and dependence. Drug Alcohol Depend. 2008; 99(1-3):338-44. DOI: 10.1016/j.drugalcdep.2008.07.017. View

Sohler N, Li X, Kunins H, Sacajiu G, Giovanniello A, Whitley S . Home- versus office-based buprenorphine inductions for opioid-dependent patients. J Subst Abuse Treat. 2009; 38(2):153-9. PMC: 2849656. DOI: 10.1016/j.jsat.2009.08.001. View

Kissin W, McLeod C, Sonnefeld J, Stanton A . Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006; 25(4):91-103. DOI: 10.1300/J069v25n04_09. View

Netherland J, Botsko M, Egan J, Saxon A, Cunningham C, Finkelstein R . Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2008; 36(3):244-51. PMC: 2866292. DOI: 10.1016/j.jsat.2008.06.006. View

Rosado J, Walsh S, Bigelow G, Strain E . Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone. Drug Alcohol Depend. 2007; 90(2-3):261-9. PMC: 2094723. DOI: 10.1016/j.drugalcdep.2007.04.006. View

Cunningham C, Giovanniello A, Sacajiu G, Whitley S, Mund P, Beil R . Buprenorphine treatment in an urban community health center: what to expect. Fam Med. 2008; 40(7):500-6. PMC: 2840630. View

10.

Reynaud M, Petit G, Potard D, Courty P . Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction. 1999; 93(9):1385-92. DOI: 10.1046/j.1360-0443.1998.93913859.x. View

11.

Moller H . Effectiveness and safety of benzodiazepines. J Clin Psychopharmacol. 1999; 19(6 Suppl 2):2S-11S. DOI: 10.1097/00004714-199912002-00002. View

12.

Lee J, Grossman E, DiRocco D, Gourevitch M . Home buprenorphine/naloxone induction in primary care. J Gen Intern Med. 2008; 24(2):226-32. PMC: 2628995. DOI: 10.1007/s11606-008-0866-8. View

13.

Strain E, Preston K, Liebson I, Bigelow G . Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone. J Pharmacol Exp Ther. 1995; 272(2):628-38. View

14.

Soyka M, Zingg C, Koller G, Kuefner H . Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study. Int J Neuropsychopharmacol. 2008; 11(5):641-53. DOI: 10.1017/S146114570700836X. View

15.

OConnor P, Oliveto A, Shi J, Triffleman E, Carroll K, Kosten T . A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic. Am J Med. 1998; 105(2):100-5. DOI: 10.1016/s0002-9343(98)00194-6. View