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Annals of Family Medicine 5:146-150 (2007)
© 2007 Annals of Family Medicine, Inc.
doi: 10.1370/afm.665
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Treating Opioid Addiction With Buprenorphine-Naloxone in Community-Based Primary Care Settings

Ira L. Mintzer, MD1, Mark Eisenberg, MD2, Maria Terra, BA1, Casey MacVane, MD, MPH2, David U. Himmelstein, MD1 and Steffie Woolhandler, MD1

1 Harvard Medical School/Cambridge Health Alliance, Cambridge, Mass
2 MGH-Charlestown HealthCare Center/Harvard Medical School, Boston, Mass

CORRESPONDING AUTHOR: Ira L. Mintzer, MD, The Cambridge Hospital, 1493 Cambridge St, Cambridge, MA 02139, imintzer{at}challiance.org

PURPOSE Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in nonresearch clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings.

METHODS We studied a cohort of 99 consecutive patients enrolled in buprenor-phine-naloxone treatment for opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic, and a primary care practice in a free-standing neighborhood health center. The primary outcome measure was sobriety at 6 months as judged by the treating physician based on periodic urine drug tests, as well as frequent physical examinations and questioning of the patients about substance use.

RESULTS Fifty-four percent of patients were sober at 6 months. There was no significant correlation between sobriety and site of care, drug of choice, neighborhood poverty level, or dose of buprenorphine-naloxone. Sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.

CONCLUSIONS Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources. Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings.

Key Words: Opiate addiction • narcotic addiction/drug therapy • narcotic antagonists • substance abuse • primary health care • primary care issues • research, practice-based • patient selection




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TRACK Comments:

Read all TRACK Comments

Data for Evidence-based Practice Guidelines are Needed
Richard D. Blondell, MD
Annals of Family Medicine, 27 Mar 2007 [Full text]
Opioid Addiction Treatment in Primary Care Practice
Mark J. Albanese
Annals of Family Medicine, 28 Mar 2007 [Full text]
Relapse and drug diversion
Ira L. Mintzer, et al.
Annals of Family Medicine, 28 Mar 2007 [Full text]
buprenorphine is underused by primary care physicians
Kevin Fiscella
Annals of Family Medicine, 28 Mar 2007 [Full text]
buprenorphine is underused by primary care physicians
Ira L. Mintzer
Annals of Family Medicine, 29 Mar 2007 [Full text]
Blocking the cause is better than substituting the cure
Andrrew J Ashworth
Annals of Family Medicine, 1 Apr 2007 [Full text]
Agonist/antogonist roles
Ira L. Mintzer
Annals of Family Medicine, 2 Apr 2007 [Full text]
Routine family practice has treated fifty patients with SUBOXONE
Robert H Hall, et al.
Annals of Family Medicine, 26 Apr 2007 [Full text]
dispensing buprenorphine/naloxone
Ira L. Mintzer
Annals of Family Medicine, 30 Apr 2007 [Full text]

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