Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence
JAMA Internal MedicinePublished 20 October 2014Open access
David A. Fiellin, Richard S. Schottenfeld, Christopher J. Cutter, Brent A. Moore, Declan T. Barry, Patrick G. O’Connor
Citations183
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Tapering is less efficacious than ongoing maintenance treatment in patients with prescription opioid dependence who receive buprenorphine therapy in primary care.
Abstract
clinicaltrials.gov Identifier: NCT00555425.
Keywords
PsychologyMedicine
Encyclopedia of Social WorkDiagnostic and Statistical Manual of Mental Disorders
109,983 Citations2013Janet B. W. Williams, Michael B. First
Computers Environment and Urban SystemsStatistical power analysis for the behavioral sciences
65,645 Citations1990
Relapse prevention: Maintenance strategies in the treatment of addictive behaviors, 2nd ed.
2,769 Citations2005G. Alan Marlatt, Dennis M. Donovan
Haug, Sorensen, Gruber, Song, Relapse Prevention for Opioid Dependence, and Wheeler, George, Stoner, Enhancing the Relapse prevention model for Sex Offenders: Adding Recidivism Risk Reduction Therapy to Target Offenders' Dynamic Risk Needs.
Generalized Estimating Equations
1,670 Citations2002James W. Hardin, Joseph M. Hilbe
New England Journal of MedicineMedication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic
988 Citations2014Nora D. Volkow, Thomas R. Frieden +2 more
The Department of Health and Human Services is working to reduce opioid abuse while ensuring appropriate access to opioids, one key element of the solution is greater use of medication-assisted therapies for addiction.
The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome
912 Citations1991John C. Ball, Alan O. Ross
British Journal of AddictionReliability of a Timeline Method: assessing normal drinkers' reports of recent drinking and a comparative evaluation across several populations
791 Citations1988Linda C. Sobell, Mark B. Sobell +2 more
Since the TL method has now been shown to have fairly good reliability for assessing recent drinking across a broad range of drinkers, it can be used for comparative evaluations of drinking behaviour across studies with different subject populations.
Archives of General PsychiatryAdjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence
534 Citations2011Roger D. Weiss
Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off bupreliminary treatment, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.
The Lancet1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial
473 Citations2003Johan Kakko, Kerstin Svanborg +2 more
The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious, and should be added to the treatment options available for individuals who are dependent on heroin.
International Journal of Drug Policy“Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting
435 Citations2013Sarah G. Mars, Philippe Bourgois +3 more
A nationwide up-cycle of heroin use may be occurring among young inner city, suburban and rural youth fueled by widespread prescription opioid pill use.
JAMAMethadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence
417 Citations2000Karen L. Sees, Kevin Delucchi +6 more
The results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors and provide support for diverting resources from MMT into long-term detoxification.
Journal of Consulting and Clinical PsychologyEfficacy of relapse prevention: A meta-analytic review.
409 Citations1999Jennifer E. Irvin, Clint Bowers +2 more
RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment using uncontrolled pre-post tests.
The American StatisticianReview of Software to Fit Generalized Estimating Equation Regression Models
360 Citations1999Nicholas J. Horton, Stuart R. Lipsitz
This article focuses on the user interface, accuracy, and completeness of implementations of the GEE methodology, which was formalized to extend generalized linear models (GLMs) to a regression setting with correlated observations within subjects.
New England Journal of MedicineCounseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence
352 Citations2006David A. Fiellin, Michael V. Pantalon +5 more
Among patients receiving buprenorphine-naloxone in primary care for opioid dependence, the efficacy of brief weekly counseling and once-weekly medication dispensing did not differ significantly from that of extended weekly Counseling and thrice-weekly dispensing.
JAMAExtended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth
350 Citations2008George Woody, Sabrina Poole +14 more
Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification, and extended medication-assisted therapy may be more helpful for young individuals with opioid dependence.
Controlled Clinical TrialsProperties of the urn randomization in clinical trials
305 Citations1988Lee‐Jen Wei, John M. Lachin
The large-sample permutational null distributions of linear rank statistics for testing the equality of treatment groups based on the urn design are described and a combined covariate-adjusted test of treatment effect is described.
Substance Use & MisuseMethadone Maintenance and Addicts' Risk of Fatal Heroin Overdose
255 Citations1996John R. M. Caplehorn, Martha Dalton +3 more
An admission cohort of 296 Australian methadone maintenance patients was followed over 15 years and a meta-analysis showed the reduction in overall mortality was consistent with the results of cohort studies conducted in the United States, Sweden, and Germany.
Archives of Internal MedicineCollaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine
253 Citations2011Daniel P. Alford, Colleen LaBelle +5 more
Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.
Drug and Alcohol DependenceAlcohol and opioid dependence medications: Prescription trends, overall and by physician specialty
247 Citations2008Tami L. Mark, Cheryl A. Kassed +3 more
While acamprosate and buprenorphine grew rapidly after market entry, overall substance abuse retail medication sales remain small relative to the size of the population that could benefit from treatment and relative to sales for other medications, such as antidepressants.
Annals of Internal MedicineDose-Response Effects of Methadone in the Treatment of Opioid Dependence
234 Citations1993Eric C. Strain, Maxine L. Stitzer +2 more
This controlled clinical trial compared moderate and low methadone dosing to methad one-free treatment, providing data in a contemporary population sample of opioid addicts and examining the effect of methamphetamineadone dose on cocaine as well as opioid use.
Journal of General Internal MedicineOffice-Based Management of Opioid Dependence with Buprenorphine: Clinical Practices and Barriers
221 Citations2008Alexander Y. Walley, Julie Alperen +5 more
Capacity for increased buprenorphine prescribing exists among physicians who have already obtained a waiver to prescribe, and increased efforts to link waivered physicians with opioid-dependent patients and initiatives to improve institutional support may mitigate barriers to bupenorphine treatment.
American Journal on AddictionsIllicit Use of Opioids: Is OxyContin® a “Gateway Drug”?
178 Citations2007Lauretta E. Grau, Nabarun Dasgupta +5 more
Polyopioid use within the first year of initiation was associated with quicker progression to heroin and injection drug use and OxyContin users could only be distinguished from heroin users.
The American Journal of MedicineA Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine
159 Citations2012David A. Fiellin, Declan T. Barry +5 more
Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician Management plus cognitive behavioral therapy.
Journal of General Internal MedicinePrimary Care Office-based Buprenorphine Treatment: Comparison of Heroin and Prescription Opioid Dependent Patients
155 Citations2007Brent A. Moore, David A. Fiellin +5 more
Individuals dependent on prescription opioids have an improved treatment response to buprenorphine/naloxone maintenance in an office-based setting compared to those who exclusively or episodically use heroin.
Journal of Substance Abuse TreatmentBuprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year
143 Citations2009Janet M. Soeffing, Lynn D. Martin +3 more
The prescription of buprenorphine for opioid dependence treatment can be incorporated into primary care practice, and many patients, including polysubstance users, benefit from this treatment.
AddictionTransition from first illicit drug use to first injection drug use among rural Appalachian drug users: a cross‐sectional comparison and retrospective survival analysis
142 Citations2011April M. Young, Jennifer R. Havens
In Appalachia, in the United States, the prescription opioid OxyContin is widely used non-medically and appears to show a particularly high risk of rapid transition to injection compared with the use of other illicit drugs.
Drug and Alcohol DependenceOne-year mortality rates following methadone treatment discharge
140 Citations1998David A. Zanis, George Woody
Death rates, especially overdose, are high among patients who are unfavorably discharged or drop out of methadone treatment, and efforts should be made to retain these at-risk patients in methadon treatment even though treatment response may be suboptimal.
Journal of General Internal MedicineIntegrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study
130 Citations2008Declan T. Barry, Kevin S. Irwin +8 more
Dressing physicians’ perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.
AddictionComparison of behavioral treatment conditions in buprenorphine maintenance
127 Citations2013Walter Ling, Maureen Hillhouse +3 more
There remains no clear evidence that cognitive behavioural therapy and contingency management reduce opiate use when added to buprenorphine and medical management in opiate users seeking treatment.
Drug and Alcohol DependenceDiversion and abuse of buprenorphine: Findings from national surveys of treatment patients and physicians
117 Citations2011Chris‐Ellyn Johanson, Cynthia L. Arfken +2 more
The increases in diversion and abuse measures indicate the need to take active attempts to curb diversion and Abuse as well as continuous monitoring and surveillance of all buprenorphine products, although these increases parallel the increased number of tablets sold.
Drug and Alcohol DependenceThe practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment?
110 Citations2005Lynn E. Sullivan, Marek C. Chawarski +3 more
The results suggest that office-based treatment of opioid dependence is associated with new types of patients entering into treatment and treatment outcomes with buprenorphine in a PCC do not vary based on history of prior methadone treatment.
Journal of Addictive DiseasesExperiences of a National Sample of Qualified Addiction Specialists Who Have and Have Not Prescribed Buprenorphine for Opioid Dependence
108 Citations2006Wendy Kissin, Caroline McLeod +2 more
Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 show high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion.
Journal of General Internal MedicineBRIEF REPORT: Methadone Treatment of Injecting Opioid Users for Prevention of HIV Infection
93 Citations2005Linda Gowing, Michael Farrell +3 more
Methadone maintenance treatment for injecting drug users significantly reduces the risk of transmission of HIV and should be provided as a component of a strategic approach to the prevention and control of HIV infection.
JAMA PsychiatryA Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers
91 Citations2013Stacey C. Sigmon, Kelly E. Dunn +6 more
Results suggest that a meaningful subset of PO-dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention, followed by buprenorphine stabilization dose.
Health AffairsThe Evidence Doesn’t Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine
85 Citations2011Robin E. Clark, Mihail Samnaliev +2 more
Buprenorphine appears to have significantly expanded access to treatment because the drug can be prescribed by a physician and taken at home compared with methadone, which by law must be administered at an approved clinic.
Journal of General Internal MedicineThe Physician Clinical Support System-Buprenorphine (PCSS-B): a Novel Project to Expand/Improve Buprenorphine Treatment
68 Citations2010James E. Egan, Paul Casadonte +8 more
The PCSS-B model provides support for a mentorship program to assist non-specialty physicians in the provision of buprenorphine and may serve as a model for dissemination of other types of care.
Biometrical JournalGeneralized Estimating Equations in Controlled Clinical Trials: Hypotheses Testing
61 Citations2004G Dahmen, Andreas Ziegler
From theoretical results in the literature, recommendations how GEE should be used in therapeutic studies for testing statistical hypotheses are derived and this paper is the starting point for a thorough discussion on the most appropriate analysis of controlled clinical trials with clustered dependent variables.
Statistics in MedicineWhat can go wrong when you assume that correlated data are independent: an illustration from the evaluation of a childhood health intervention in Brazil
53 Citations2001Michael J. Cannon, Lee Warner +2 more
Using the example of a childhood health intervention in Brazil, this work illustrates how ignoring correlation leads to incorrect conclusions about the effectiveness of the intervention.
Annals of Internal MedicinePrescription Drug Abuse: Executive Summary of a Policy Position Paper From the American College of Physicians
51 Citations2013Neil Kirschner, Jack Ginsburg +1 more
A mobile app may be a viable option to monitor the abuse of prescription drugs in the future and provide real-time information about which medications to prescribe and when to use.
PharmacopsychiatryDetoxification of Opiate Addicts with Multiple Drug Abuse: a Comparison of Buprenorphine vs. Methadone
44 Citations2002J. Seifert, C Metzner +7 more
The hypothesis that buprenorphine/carbamazepine is more effective than methadone/carbazepine in detoxification strategies for opioid addict with additional multiple drug abuse is supported.
Journal of Addiction MedicineA Comparison of Buprenorphine Taper Outcomes Between Prescription Opioid and Heroin Users
43 Citations2012Suzanne Nielsen, Maureen Hillhouse +3 more
Despite greater comorbidity, PO users seem to have favorable taper outcomes compared with heroin users, and patients may taper from buprenorphine as part of a treatment plan.
Journal of Substance Abuse TreatmentAvailability of addiction medications in private health plans
36 Citations2007Constance M. Horgan, Sharon Reif +3 more
It is found that pharmacy benefits have an impact on access to medications for substance abuse, and generic naltrexone is the only substance dependence medication that is both rarely excluded from formularies and usually placed on a lower cost-sharing tier.
Addiction BiologyMood and affect during detoxification of opiate addicts: a comparison of buprenorphine versus methadone
31 Citations2005J. Seifert, C Metzner +9 more
The hypothesis that the combination of buprenorphine and carbamazepine leads to a better clinical outcome than does a combination of methadone and carbazepine in the detoxification of opioid addicts with additional multiple drug abuse is supported.
JAMA Internal MedicineResponses of State Medicaid Programs to Buprenorphine Diversion
30 Citations2013Robin E. Clark, Jeffrey D. Baxter
Buprenorphine carries a lower risk of sedation and overdose; it can more safely be dispensed for unsupervised use at home, and the requirement for on-site dosing creates challenges for work and family life.
Drug and Alcohol DependenceTransitioning opioid-dependent patients from detoxification to long-term treatment: Efficacy of intensive role induction
24 Citations2011Elizabeth C. Katz, Barry S. Brown +4 more
It is demonstrated that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.
Drug and Alcohol DependenceMedicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA
12 Citations2010Jae Kennedy, Aaron Dipzinski +3 more
While Medicare prescription plans usually cover pharmacotherapeutic treatments for drug addiction, high co-payments can limit access, and the 2010 Patient Protection and Affordable Care Act will gradually eliminate this coverage gap.
Journal of Addictive DiseasesBuprenorphine and Methadone
11 Citations2007Richard D. Blondell, Susan J. Smith +3 more
It is concluded that as compared to methadone, buprenorphine is associated with greater rates of completion of inpatient detoxification.
