TY - JOUR
T1 - A comparison of buprenorphine induction strategies
T2 - Patient-centered home-based inductions versus standard-of-care office-based inductions
AU - Cunningham, Chinazo O.
AU - Giovanniello, Angela
AU - Li, Xuan
AU - Kunins, Hillary V.
AU - Roose, Robert J.
AU - Sohler, Nancy L.
N1 - Funding Information:
This study was 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 the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program . A portion of this work was presented at the Society of General Internal Medicine Annual Conference on April 2010 in Minneapolis, MN. We thank Mia Brisbane and Johanna Rivera for their help in conducting this research.
PY - 2011/6
Y1 - 2011/6
N2 - Although novel buprenorphine induction strategies are emerging, they have been inadequately studied. To examine our newly developed patient-centered home-based inductions, we conducted a subgroup analysis of 79 opioid-dependent individuals who had buprenorphine inductions at an urban community health center. Participants chose their induction strategy. Standard-of-care office-based inductions were physician driven, with multiple assessments, and observed, and the patient-centered home-based inductions emphasized patient self-management and included a "kit" for induction at home. We conducted interviews and extracted medical records. Using mixed nonlinear models, we examined associations between induction strategy and opioid use and any drug use. Compared with those with standard-of-care office-based inductions, participants with patient-centered home-based inductions had no significant differences in opioid use (adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.13-2.97) but greater reductions in any drug use (AOR = 0.05, 95% CI = 0.01-0.37). Taking into account the limitations of our observational cohort study design, we conclude that participants with patient-centered home-based inductions had similar reductions in opioid use and greater reductions in any drug use than those with standard-of-care office-based inductions. It is essential that new induction strategies be based on existing models or theories and be well studied.
AB - Although novel buprenorphine induction strategies are emerging, they have been inadequately studied. To examine our newly developed patient-centered home-based inductions, we conducted a subgroup analysis of 79 opioid-dependent individuals who had buprenorphine inductions at an urban community health center. Participants chose their induction strategy. Standard-of-care office-based inductions were physician driven, with multiple assessments, and observed, and the patient-centered home-based inductions emphasized patient self-management and included a "kit" for induction at home. We conducted interviews and extracted medical records. Using mixed nonlinear models, we examined associations between induction strategy and opioid use and any drug use. Compared with those with standard-of-care office-based inductions, participants with patient-centered home-based inductions had no significant differences in opioid use (adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.13-2.97) but greater reductions in any drug use (AOR = 0.05, 95% CI = 0.01-0.37). Taking into account the limitations of our observational cohort study design, we conclude that participants with patient-centered home-based inductions had similar reductions in opioid use and greater reductions in any drug use than those with standard-of-care office-based inductions. It is essential that new induction strategies be based on existing models or theories and be well studied.
KW - Buprenorphine
KW - Buprenorphine induction
KW - Drug use
KW - Opioid
KW - Opioid addiction treatment
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=79955092837&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955092837&partnerID=8YFLogxK
U2 - 10.1016/j.jsat.2010.12.002
DO - 10.1016/j.jsat.2010.12.002
M3 - Article
C2 - 21310583
AN - SCOPUS:79955092837
SN - 0740-5472
VL - 40
SP - 349
EP - 356
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
IS - 4
ER -