Tags

Type your tag names separated by a space and hit enter

Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial.
JAMA Intern Med. 2014 Aug; 174(8):1369-76.JIM

Abstract

IMPORTANCE

Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known.

OBJECTIVE

To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization.

DESIGN, SETTING, AND PARTICIPANTS

From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group.

INTERVENTIONS

Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage).

MAIN OUTCOMES AND MEASURES

Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report).

RESULTS

During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis.

CONCLUSIONS AND RELEVANCE

Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00987961.

Links

PMC Free PDF

Authors+Show Affiliations

Liebschutz JM
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Crooks D
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Herman D
Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Anderson B
Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Tsui J
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Meshesha LZ
Department of Psychology, The University of Memphis, Memphis, Tennessee.
Dossabhoy S
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Stein M
Department of General Internal Medicine, Butler Hospital, Providence, Rhode Island4Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.

MeSH

AdultAmbulatory CareBuprenorphineFemaleHospitalizationHumansMaleMiddle AgedNarcoticsOpiate Substitution TreatmentOpioid-Related DisordersPatient DischargeTreatment Outcome

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25090173

Clinical Trial Links

Clinical trial which this article describes
EXHIT ENTRE Comparative Effectiveness Trial

Citation

Liebschutz, Jane M., et al. "Buprenorphine Treatment for Hospitalized, Opioid-dependent Patients: a Randomized Clinical Trial." JAMA Internal Medicine, vol. 174, no. 8, 2014, pp. 1369-76.
Liebschutz JM, Crooks D, Herman D, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1369-76.
Liebschutz, J. M., Crooks, D., Herman, D., Anderson, B., Tsui, J., Meshesha, L. Z., Dossabhoy, S., & Stein, M. (2014). Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Internal Medicine, 174(8), 1369-76. https://doi.org/10.1001/jamainternmed.2014.2556
Liebschutz JM, et al. Buprenorphine Treatment for Hospitalized, Opioid-dependent Patients: a Randomized Clinical Trial. JAMA Intern Med. 2014;174(8):1369-76. PubMed PMID: 25090173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. AU - Liebschutz,Jane M, AU - Crooks,Denise, AU - Herman,Debra, AU - Anderson,Bradley, AU - Tsui,Judith, AU - Meshesha,Lidia Z, AU - Dossabhoy,Shernaz, AU - Stein,Michael, PY - 2014/8/5/entrez PY - 2014/8/5/pubmed PY - 2014/12/15/medline SP - 1369 EP - 76 JF - JAMA internal medicine JO - JAMA Intern Med VL - 174 IS - 8 N2 - IMPORTANCE: Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known. OBJECTIVE: To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization. DESIGN, SETTING, AND PARTICIPANTS: From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group. INTERVENTIONS: Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital's primary care clinic (linkage). MAIN OUTCOMES AND MEASURES: Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report). RESULTS: During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P < .001). At 6 months, 12 linkage participants (16.7%) and 2 detoxification participants (3.0%) were receiving buprenorphine OAT (P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P < .01) in an intent-to-treat analysis. CONCLUSIONS AND RELEVANCE: Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00987961. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/25090173/Buprenorphine_treatment_for_hospitalized_opioid_dependent_patients:_a_randomized_clinical_trial_ DB - PRIME DP - Unbound Medicine ER -