Introduction: Opioid dependence is a serious and growing public health issue. Treatment options have expanded since buprenorphine was approved for use as a maintenance medication by primary care providers in outpatient settings, but use of this medication is sti11limited. The safety and efficacy of buprenorphine have been well established, but very little is understood about what contributes to the success of some patients in these programs. The objective of this study is to describe factors that affect the efficacy of buprenorphine and naloxone as a replacement medication in treating opioid dependence in the primary care setting in Mendocino County, California.
Methods: The 27 patients who currently are or have been involved in the buprenorphine program at Mendocino Coast Clinics (MCC) were included in this descriptive study. A patient information form was designed, . and a chart review of all subjects was completed to collect demographic and other information. Retention in treatment as defined by current involvement in the program was the outcome measure to define success. The buprenorphine program psychologist was interviewed to collect additional psychosocial information about all 10 subjects in the successful cohort. 6 of the successful subjects completed a written survey about their experiences with opioids and the buprenorphine program. Content · analysis of the patient information forms and surveys was then conducted and the data was categorized and described using frequency distributions.
Results: There has been a 37% success rate for patients in the MCC buprenorphine program, and most of the subjects who have ' not been successful either failed at induction or quit because they were unable to comply with the program and refrain from drug use. When compared to the unsuccessful subjects, the successful subjects: were older, had a longer history of opioid dependence, were not as involved in numerous other therapeutic modalities, had less co.-morbid substance use and dependence, and used more' medications for management of mental disorders and pain. There were trends in psychosocial variable changes among the successful subjects during their time in the buprenorphine program in areas including: employment pattern, housing and living situation, household income, and social environment. The Global Assessment of Functioning (GAF) scores of successful subjects increased with their involvement in the buprenorphine program. The survey of successful subjects indicated that they tolerate the medication, have low opioid cravings while taking buprenorphine, and find the program helpful. They also identified their primary support group and social environment as most helpful with their success, and several subjects specifically identified the buprenorphine program . physician and psychologist as especially · supportive and helpful. Most successful subjects preferred buprenorphine to methadone or other programs because it provides maintenance opioid doses, provides ' support, and does not require daily appointments. Discussion: This study represents a small group in a geographically isolated area, but there are trends that may be worthy of further study. Further exploration of the subgroup for whom the program is more successful may help in patient selection for these treatment programs with limited space. Buprenorphine programs may also be designed to provide a supportive induction, medically manage pain and co-morbid mental disorders, and address psychosocial factors and provide support.
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