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A Randomized Trial of Extended Buprenorphine Detoxification for Opioid Dependency

Blondell, Richard D. MD; Frydrych, Lynne M. MS; Arber, Bethany C. MD; Bashaw, Heather L. BA; Vexler, Albert PhD; Purdy, Christopher H. MA; Sawyer, Rita M. MSN; Okazaki, Saburo MD

doi: 10.1097/ADM.0b013e31816859a4
Original Article

Objective: The objective of this study was to determine whether additional “take-home” medication after inpatient opioid detoxification would lead to improved rates of subsequent treatment initiation and abstinence.

Methods: We randomly assigned 60 inpatients to a 7-day or 37-day extension of sublingual buprenorphine/naloxone after hospitalization. Follow-up telephone interviews were conducted approximately 5 weeks after discharge. The primary outcomes were abstinence, initiation of aftercare outpatient counseling, and initiation of self-help meeting attendance.

Results: Of the 30 participants in each group, outcome data were obtained for 25 (83%) in the 7-day extension group and 27 (90%) in the 37-day extension group. There was not a significant difference in the rates of abstinence (53% versus 41%) or initiation of self-help (57% versus 54%) between the 7-day and 37-day groups, respectively. Of those in the 7-day group, 15 (65%) initiated outpatient treatment compared with 21 (88%) of those assigned to the 37-day group. Although not significant in unadjusted analysis (P = 0.093), this difference was significant in regression analysis when controlling for a history of intravenous drug use (P = 0.034). Among all participants, individual characteristics at the time of hospital admission (eg, age of first drug use, previous history of intravenous drug, type of health insurance) were predictive of outcomes.

Conclusions: In this preliminary study, additional medication beyond a week after inpatient detoxification was not associated with clinically important improvements in rates of abstinence or treatment initiation. Baseline patient characteristics seem to affect these clinical outcomes after hospitalization.

From the Department of Family Medicine, Family Medicine Research Institute, Buffalo, NY; and The State University of New York, University at Buffalo, Buffalo, NY.

Received September 28, 2007; revised December 28, 2007; accepted January 6, 2008.

Send correspondence and reprint requests to Richard D. Blondell, MD, 462 Grider Street CC-190, Buffalo, NY 14215. e-mail: blondell@buffalo.edu

Supported, in part, by a grant (K23 AA 015616) from the National Institute on Alcohol Abuse and Alcoholism (RDB and LMF) and by a grant from the University of Buffalo Interdisciplinary Research Fund (HLB).

© 2008 American Society of Addiction Medicine