Buprenorphine Outpatient Outcomes Project

Lowering_The_Bar_Cover_2010.09.22I recently came across this 2014 study of 220 buprenorphine patients.

I mentioned it in another post and noted this sentence from the conclusion as underwhelming, “The number of legal charges for drug possession decreased from 70 to 62.”

Turns out that this sentence casts their outcomes in a misleadingly positive light. In the year before buprenorphine subjects were charged with 221 crimes. In the year following initiation of buprenorphine, they were charged with 237.

Though cumulatively the number of charges increased from the year prior to starting treatment to the year after, the number of some individual types of charges dropped. Most noticeably, the number of charges for illicit drug possession decreased from 70 charges in the year prior to 62 charges in the year after starting treatment. Other types of charges that also decreased in number were prostitution, fraud, violation of probation, and trespassing.

What about retention in the study?

While most participants were only in the study for less than 1 month (137, 62%), 46 (21%) remained for 1–3 months, and 37 (17%) participated for more than 3 months.

So, the retention numbers are as follows:

  • 62% dropped out by day 30.
  • 83% dropped out by day 90.

The abstract said that “Ten of the 37 [retained for a full year] (27%) never relapsed after their longest period of abstinence from heroin. ” I’m not sure what “after their longest period of abstinence from heroin” means but 10 subjects is 4.5% of the 220 subjects.

The study also attempts to measure some quality of life outcomes, BUT they only report on the 13% who were retained for a year.

So,

  • extremely poor retention,
  • high relapse rates, and
  • reports of quality of life improvements are limited to the 13% retained for a year.

What did the researcher conclude from these findings?

Overall, Suboxone is an effective treatment method for heroin addiction and is a viable outpatient therapy option.

Next time you hear someone assert that drugs like buprenorphine are the most effective treatment, keep in mind that studies like this are part of the evidence-based used to support this position.

3 Comments

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3 responses to “Buprenorphine Outpatient Outcomes Project

  1. Are there any studies showing more favorable results? Also, abstaining from heroin is less of a desired outcome if people abuse benzos, alcohol or opiate pain killers. Wonder if there are any studies on that?

    • There are studies that show better outcomes. The early studies showed really strong outcomes, but there appears to be a decline effect. The problem is that negative outcomes get little attention and negative outcomes get spun as positive outcomes.

      One issue with a lot of these studies is whether what they measure gets properly understood and communicated to readers. Some look for abstinence from all illegal drugs, other only look at abstinence from opioids, others look at reductions in use of drugs.

      This is why it’s so important for consumers to make sure that the “effectiveness” outcomes that media and providers refer to match the desired outcomes for the consumer and their family. If the research shows it’s effective at reducing drug use but your goal is abstinence, it might not be the right treatment for you and your loved one.

  2. Jason, I guess that the main question that I would want to ask you is “do you consider a patient medicated by an addiction medicine physician on buprnorphine, to be abstinent”? Please don’t explain that buprenorphine is a narcotic, I am very familiar with the vast differences in effect of a partial agonist to a full agonist.
    I would question the study’s definition of outpatient (treatment) as consisting of “maintenance treatment and counseling”, in which the patients were only seen on a weekly basis for the first month, bi-weekly for a month and every 2 weeks in the second month”. It appears that the patients were never in group therapy and, simply, seen by a resident physician to discuss how they were doing on their current dose.
    We both know that this would not consist of treatment in any program, in which I have worked or directed. The least, that our patients are seen is once for three hours with their families, again for three more days at three hour group therapy sessions. They would, also, receive individual counseling from a clinician and be encouraged to attend 12 step meetings. Now, that is a description of the lowest level and intensity of any of our programs. Other programming, includes six hours a day five days a week with family therapy and regular drug testing.
    In fact, Jason, if we look at the few studies that have been done that we could compare to this, we would find that patient retention, ultimately, resulted in the study being discontinued because all of the patients had relapsed to heroin on an abstinence only basis.
    I wish that you would give parents or loved ones the components that they should be looking for in a program that has superior outcomes where the goal is abstinence. There are other studies that would caution parents that within 120 of discharge from a residential program, the overdose death rate is 75 times the rate of those opiate addicts just released from prison or who have stayed on the streets. It is lacks integrity to cherry pick the points that support your premise and ignore the rest of the information that led the authors of the study to determine that caused them to state “Suboxone is a viable treatment option for heroin addiction in a closely monitored inpatient-to-outpatient setting and, more importantly, can be a part of a standard outpatient doctor-patient relationship”.”Advantages of using suboxone have been studied in the past and include lower dependence, less tolerance milder withdrawal symptoms, lower risk of fatal overdosing and longer lasting action”. You left off “counseling must be made a mandatory part of treatment with suboxone, as this allows for treatment of the mental and emotional aspects of heroin addiction”. They identified their own problems in their study and ways to improve but you didn’t mention that part of the study.
    Just so that we can be clear that this was not one of those pharma scams that we hear about all the time the authors state: the authors have no conflict of interest. Funding was provided by a generous grand from the State of Maryland’s Department of Health and Mental Hygiene”.
    Why would these researchers go on and on to extoll the benefits of buprenorphine if it weren’t true. Where is their bias and where is yours?
    Respectfully submitted and I appreciate the effort that you have expended in bringing this topic to the forefront.