Buprenorphine Treatment for Opioid Use Disorder in Community-Based Settings: Outcome Related to Intensity of Services and Urine Drug Test Results

Marc Galanter, John Femino, Brooke Hunter, Mary Hauser, Marc Galanter, John Femino, Brooke Hunter, Mary Hauser

Abstract

Background and objectives: Variables contributing to the outcome of buprenorphine treatment for opiate use disorder have been studied, including patient characteristics and the treatment approach applied. It is also valuable to study the types of clinical facilities that can affect outcome.

Methods: We evaluated patients (N = 20 993) in 573 facilities where buprenorphine was prescribed. Urine drug test results were analyzed for those (N = 13 281) who had buprenorphine prescribed at least twice in the period January 2015 through June 2017. Facilities were divided into three categories: medication management (MM) only, limited psychosocial (LP) therapy, and recovery-oriented (with more extensive counseling and a 12-step orientation) (RO).

Results: Urine drug tests negative for other opioids at the time of the second buprenorphine prescription were 34% for MM, 56% for LP, and 62% for RO (P < .001). A comparison was made between the most recent and the established patients at the facilities. The decrement in urinalyses positive for other opioids in this latter comparison was 3% for MM, 7% for LP, and 23% for RO (P < .001).

Discussion and conclusions: In a large sample of community settings, buprenorphine patients' urinalyses positive for opioids can vary considerably across treatment facilities, and more intensive recovery orientation may yield a better outcome in terms of secondary opioid use.

Scientific significance: The majority of buprenorphine patients are treated in community facilities. It is important that research be done by facility type in such settings in order to plan for optimal treatment. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals, Inc.;00:00-00).

© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP).

Figures

Figure 1
Figure 1
Patients who had a urine toxicology positive for buprenorphine. BE = buprenorphine episode.

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