Opioid Dependence: Buprenorphine Maintenance May Be Better Than Taper for Treatment Retention

David A. Fiellin, M.D. Professor of Medicine, Investigative Medicine and Public Health Yale University School of MedicineMedicalResearch.com Interview with
David A. Fiellin, M.D.
Professor of Medicine, Investigative Medicine and Public Health
Yale University School of Medicine

 

Medical Research: What are the main findings of the study?

Dr. Fiellin: The main finding of our randomized clinical trial, conducted in primary care, was that among prescription opioid dependent patients, ongoing buprenorphine therapy resulted in better treatment retention and reduced illicit opioid use when compared to buprenorphine taper (detoxification).


Medical Research:  What was most surprising about the results?

Dr. Fiellin: Only 11% of the patients who under went the buprenorphine taper completed the 14 weeks of treatment.  Only 2 of these patients went on to receive naltrexone.

Medical Research:  What should clinicians and patients take away from your report?

Dr. Fiellin: Primary care and office-based physicians who are providing buprenorphine treatment to prescription opioid dependent patients should advise their patients of the superior outcomes with ongoing maintenance treatment and be cautious about considering or offering tapering doses in the first 2-3 months of treatment.  Prescription opioid dependent patients and there family members should be aware that this condition often requires combined on-going medication, counseling and monitoring in order to be treated safely and successfully.

Medical Research:  What recommendations do you have for future research as a result of this study?

Dr. Fiellin: Future research should focus on improving retention and illicit drug use outcomes among patients receiving buprenorphine in primary care and office-based settings, and focus on implementation strategies to increase the uptake of this treatment among a greater number of providers.
Citation:

Fiellin DA, Schottenfeld RS, Cutter CJ, Moore BA, Barry DT, O’Connor PG. Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Intern Med. Published online October 20, 2014. doi:10.1001/jamainternmed.2014.5302.