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Improving Temporal Efficiency of Outpatient Buprenorphine Induction

Authors

  • Erik W. Gunderson MD,

    1. Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia, Charlottesville, Virginia
    2. Department of Psychiatry, Division of Substance Abuse, Columbia University, New York, New York
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  • Frances R. Levin MD,

    1. Department of Psychiatry, Division of Substance Abuse, Columbia University, New York, New York
    2. Department of Psychiatry, Division of Substance Abuse, New York State Psychiatric Institute, New York, New York
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  • Margaret M. Rombone PhD,

    1. Department of Psychiatry, Division of Substance Abuse, New York State Psychiatric Institute, New York, New York
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  • Suzanne K. Vosburg PhD,

    1. Department of Psychiatry, Division of Substance Abuse, Columbia University, New York, New York
    2. Department of Psychiatry, Division of Substance Abuse, New York State Psychiatric Institute, New York, New York
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  • Herbert D. Kleber MD

    1. Department of Psychiatry, Division of Substance Abuse, Columbia University, New York, New York
    2. Department of Psychiatry, Division of Substance Abuse, New York State Psychiatric Institute, New York, New York
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These data were presented, in part, at the 66th Annual Scientific Meeting for the College of Problems on Drug Dependence, San Juan, PR, June 12–17, 2004. Address correspondence to Dr. Gunderson, University of Virginia Health System, Box 800623, Charlottesville, VA 22908. E-mail: erikgunderson@virginia.edu.

Abstract

Buprenorphine induction poses a barrier for physician adoption of office-based opioid dependence treatment. We conducted a retrospective chart review of the first 41 patients inducted at a newly established outpatient treatment program to examine the induction process and determine strategies associated with greater induction efficiency. Timed withdrawal scales, medication log, and notes enabled reconstruction of the initial day of buprenorphine treatment. To assess change with experience, consecutive patients were divided into three chronological groups for analyses (Phases 1–3). The time required for induction was substantial in Phase 1 (mean 5.5 hours), but temporal efficiency improved to a mean 1.5 hours spent at the program by Phase 3 (p < .001). Phase 2–3 patients arrived to the program after significantly longer opioid abstinence and were in greater withdrawal, with mean Clinical Opioid Withdrawal Scale scores of 6, 10, and 10 for Phases 1–3, respectively (p < .01). Patients in the later phases had less time delay to medication initiation, 5 minutes in Phase 3 compared to 133 minutes in Phase 1 (p < .001). The mean 7-mg buprenorphine dose administered in the office did not differ between groups, but occurred over a smaller time interval for later phases indicating more rapid titration. Patients in the later phases had more rapid withdrawal relief after buprenorphine initiation and were more likely to have used preinduction ancillary withdrawal medication. The study sheds light on the induction barrier and provides practical procedural information to inform clinical guidelines and hopefully mitigate procedural aspects of the induction barrier. (Am J Addict 2011;00:1–8)

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