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Prior Buprenorphine Experience Is Associated With Office-Based Buprenorphine Treatment Outcomes

Cunningham, Chinazo O. MD, MS; Roose, Robert J. MD, MPH; Starrels, Joanna L. MD, MS; Giovanniello, Angela PharmD; Sohler, Nancy L. PhD, MPH

doi: 10.1097/ADM.0b013e31829727b2
Original Research

Objectives: As buprenorphine treatment and illicit buprenorphine use increase, many patients seeking buprenorphine treatment will have had prior experience with buprenorphine. Little evidence is available to guide optimal treatment strategies for patients with prior buprenorphine experience. We examined whether prior buprenorphine experience was associated with treatment retention and opioid use. We also explored whether type of prior buprenorphine use (prescribed or illicit use) was associated with these treatment outcomes.

Methods: We analyzed interview and medical record data from a longitudinal cohort study of 87 individuals who initiated office-based buprenorphine treatment. We examined associations between prior buprenorphine experience and 6-month treatment retention using logistic regression models, and prior buprenorphine experience and any self-reported opioid use at 1, 3, and 6 months using nonlinear mixed models.

Results: Most (57.4%) participants reported prior buprenorphine experience; of these, 40% used prescribed buprenorphine and 60% illicit buprenorphine only. Compared with buprenorphine-naïve participants, those with prior buprenorphine experience had better treatment retention (adjusted odds ratio [AOR] = 2.65, 95% CI = 1.05-6.70). Similar associations that did not reach significance were found when exploring prescribed and illicit buprenorphine use. There was no difference in opioid use when comparing participants with prior buprenorphine experience with those who were buprenorphine-naive (AOR = 1.33, 95% CI = 0.38-4.65). Although not significant, qualitatively different results were found when exploring opioid use by type of prior buprenorphine use (prescribed buprenorphine vs buprenorphine-naïve, AOR = 2.20, 95% CI = 0.58-8.26; illicit buprenorphine vs buprenorphine-naïve, AOR = 0.47, 95% CI = 0.07-3.46).

Conclusions: Prior buprenorphine experience was common and associated with better retention. Understanding how prior buprenorphine experience affects treatment outcomes has important clinical and public health implications.

From the Albert Einstein College of Medicine (COC, RJR, JLS, AG) and Montefiore Medical Center (COC, RJR, JLS, AG), Bronx; and Sophie Davis School of Biomedical Education (NLS), City College of the City University of New York, NY.

Send correspondence and reprint requests to Chinazo Cunningham, MD, MS, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467. E-mail: ccunning@montefiore.org.

Supported by the Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance, grant 6H97HA00247; the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI-51519); NIH R25DA023021 and 5K23DA027719; and the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program.

The authors declare no conflicts of interest.

Received May 02, 2012

Accepted September 01, 2012

© 2013 American Society of Addiction Medicine