Comment; As anticipated, folks in early addiction recovery stand a better chance at long-term abstinence with greater levels of personalized support, essentially hand-delivering them to further treatmentn after the detox phases. More difficult and expensive yes, but the long-term benefits probably outweight the short-term higher costs.
Michael SteinDebra HermanMicah ContiBradley AndersonGenie BaileyFirst published: 20 August 2019 https://doi.org/10.1111/add.14737Read the full textPDFTOOLSSHARE
Abstract
Background and Aims
The effectiveness of linking people from short‐term in‐patient managed withdrawal programs (‘detoxification’) to long‐term, primary care‐based buprenorphine is unknown. We tested whether buprenorphine initiation during an opioid withdrawal program and linkage to office‐based buprenorphine (LINK) after discharge would increase engagement with office‐based buprenorphine and decrease illicit opioid use during the ensuing 6 months compared with standard withdrawal management (WM).
Design
Single‐site randomized controlled trial.
Setting
Short‐term in‐patient detoxification program in Massachusetts, USA.
Participants
People with opioid use disorder (n = 115) who averaged 32.4 years of age, 68.2% male, 79.1% white, using illicit opioids on 27.3 of the last 30 days, were randomly assigned to WM (n = 59) versus LINK (n = 56).
Intervention and comparator
Intervention was buprenorphine induction, in‐patient dose stabilization and post‐discharge transition to maintenance buprenorphine at an affiliated primary care clinic (LINK). Comparator was 5‐day buprenorphine managed withdrawal protocol (WM).
Measurements
Mean 30‐day rate of use of illicit opioids (primary aim) and prescribed buprenorphine (secondary aim) at 1, 3 and 6 months.
Findings
Compared with WM, participants in the LINK condition had lower illicit opioid use rates at days 12 [b = −6.81, 95% confidence interval (CI) = –9.69; −3.92, P < 0.001], 35 (b = −8.55, 95% CI – 11.63; −5.47, P < 0.001), 95 (b = −7.34, 95% CI = –10.59; −4.11, P < 0.001) and 185 (b = −3.52, 95% CI = –7.07; 0.27, P = 0.052). The LINK arm had higher prescription buprenorphine use rates (P < 0.001) at all assessments.
Conclusions
Among people with opioid use disorder, initiation of, and linkage to, office‐based buprenorphine treatment post‐discharge reduced illicit opioid use and increased days of buprenorphine treatment for up to 6 months post‐discharge compared with an in‐patient detoxification protocol.
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