Buprenorphine (often prescribed in a formulation with naloxone, known by brand name Suboxone) is a helpful medication for many people with opioid use disorder. Yet, relatively few opioid-addicted individuals seek it out.
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In one study called the “Suboxone Transition to Opiate Program” or “STOP”, hospitalized individuals that also had a possible opioid use problem, were given an intervention to systematically start them on buprenorphine then link them to outpatient buprenorphine treatment. When this was compared to providing medical opioid detoxification if needed and a treatment referral (“detox”), 72% of the buprenorphine linkage patients versus 12% of the detox patients showed up to subsequent buprenorphine treatment, and they had a 40% lower likelihood of illicit opioid use up to 6 months after the hospitalization.
Because injection opioid users are often more severe and present unique health care challenges compared to non-injection users, Cushman and colleagues re-analyzed these STOP data but this time investigating only the subsample of study participants who were injection opioid users.
Authors compared 51 individuals in the linkage group to 62 in the detox group, all of whom were injection heroin users. For the linkage, patients were started on buprenorphine (called “induction”) while in the hospital, then were scheduled an appointment at an outpatient primary care clinic affiliated with the hospital and given enough medication to last them until that appointment. The clinic used a “collaborative care model” which provided monitoring in addition to buprenorphine prescription, as well as nurse care managers who were responsible for the bulk of patient care.
Patients, on average, were 40 years old; 69% were male and the ethnic/racial composition was diverse with 49% White, 23% Black, 20% Latino, and 8% of another racial/ethnic background. The groups were similar on many measured characteristics when they started treatment in the hospital, including how often they used opioids, though the detox patients were more likely to have used cannabis and cocaine in the 30 days before treatment (28 vs. 45% and 53 vs. 69%, respectively), though these differences were not statistically significant.
By 1 month, linkage patients took buprenorphine, on average 22 days out of 30 (standard deviation = 10) versus 7 out of 30 in the detox group (standard deviation = 8).
Their opioid use, however, was similar during this time period, with 12 days of illicit opioid use in the linkage group (standard deviation = 8) versus 13 in the detox group (standard deviation = 8).
The initial STOP study based in hospital settings, and another study reviewed in a prior Bulletin which was based in emergency rooms both demonstrated innovative ways to engage individuals with opioid problems with helpful buprenorphine medication treatment.
In this latest analysis of the STOP study, in contrast with the positive linkage findings in the whole sample of individuals with opioid use disorder, injection users did not benefit from the active linkage to buprenorphine compared with detox and referral. As such, this study highlights the importance of examining subgroups of patients for whom the typical current standard of care may not be adequate
Suggestion in terms of what might be needed for this group of injection users, given that they were more likely to engage with buprenorphine treatment, but had similar outcomes:
More research is needed specifically on how to improve outcomes of hospitalized individuals with injection opioid use. It is possible that different combinations and intensities of medical, psychological, and community-based approaches might be needed.
Cushman, P. A., Liebschutz, J. M., Anderson, B. J., Moreau, M., & Stein, M. D. (2016). Buprenorphine Initiation and Linkage to Outpatient Buprenorphine Do Not Reduce Frequency of Injection Opiate Use Following Hospitalization. Journal of Substance Abuse Treatment.
l
In one study called the “Suboxone Transition to Opiate Program” or “STOP”, hospitalized individuals that also had a possible opioid use problem, were given an intervention to systematically start them on buprenorphine then link them to outpatient buprenorphine treatment. When this was compared to providing medical opioid detoxification if needed and a treatment referral (“detox”), 72% of the buprenorphine linkage patients versus 12% of the detox patients showed up to subsequent buprenorphine treatment, and they had a 40% lower likelihood of illicit opioid use up to 6 months after the hospitalization.
Because injection opioid users are often more severe and present unique health care challenges compared to non-injection users, Cushman and colleagues re-analyzed these STOP data but this time investigating only the subsample of study participants who were injection opioid users.
Authors compared 51 individuals in the linkage group to 62 in the detox group, all of whom were injection heroin users. For the linkage, patients were started on buprenorphine (called “induction”) while in the hospital, then were scheduled an appointment at an outpatient primary care clinic affiliated with the hospital and given enough medication to last them until that appointment. The clinic used a “collaborative care model” which provided monitoring in addition to buprenorphine prescription, as well as nurse care managers who were responsible for the bulk of patient care.
Patients, on average, were 40 years old; 69% were male and the ethnic/racial composition was diverse with 49% White, 23% Black, 20% Latino, and 8% of another racial/ethnic background. The groups were similar on many measured characteristics when they started treatment in the hospital, including how often they used opioids, though the detox patients were more likely to have used cannabis and cocaine in the 30 days before treatment (28 vs. 45% and 53 vs. 69%, respectively), though these differences were not statistically significant.
By 1 month, linkage patients took buprenorphine, on average 22 days out of 30 (standard deviation = 10) versus 7 out of 30 in the detox group (standard deviation = 8).
Their opioid use, however, was similar during this time period, with 12 days of illicit opioid use in the linkage group (standard deviation = 8) versus 13 in the detox group (standard deviation = 8).
The initial STOP study based in hospital settings, and another study reviewed in a prior Bulletin which was based in emergency rooms both demonstrated innovative ways to engage individuals with opioid problems with helpful buprenorphine medication treatment.
In this latest analysis of the STOP study, in contrast with the positive linkage findings in the whole sample of individuals with opioid use disorder, injection users did not benefit from the active linkage to buprenorphine compared with detox and referral. As such, this study highlights the importance of examining subgroups of patients for whom the typical current standard of care may not be adequate
Suggestion in terms of what might be needed for this group of injection users, given that they were more likely to engage with buprenorphine treatment, but had similar outcomes:
More research is needed specifically on how to improve outcomes of hospitalized individuals with injection opioid use. It is possible that different combinations and intensities of medical, psychological, and community-based approaches might be needed.
Cushman, P. A., Liebschutz, J. M., Anderson, B. J., Moreau, M., & Stein, M. D. (2016). Buprenorphine Initiation and Linkage to Outpatient Buprenorphine Do Not Reduce Frequency of Injection Opiate Use Following Hospitalization. Journal of Substance Abuse Treatment.
l
In one study called the “Suboxone Transition to Opiate Program” or “STOP”, hospitalized individuals that also had a possible opioid use problem, were given an intervention to systematically start them on buprenorphine then link them to outpatient buprenorphine treatment. When this was compared to providing medical opioid detoxification if needed and a treatment referral (“detox”), 72% of the buprenorphine linkage patients versus 12% of the detox patients showed up to subsequent buprenorphine treatment, and they had a 40% lower likelihood of illicit opioid use up to 6 months after the hospitalization.
Because injection opioid users are often more severe and present unique health care challenges compared to non-injection users, Cushman and colleagues re-analyzed these STOP data but this time investigating only the subsample of study participants who were injection opioid users.
Authors compared 51 individuals in the linkage group to 62 in the detox group, all of whom were injection heroin users. For the linkage, patients were started on buprenorphine (called “induction”) while in the hospital, then were scheduled an appointment at an outpatient primary care clinic affiliated with the hospital and given enough medication to last them until that appointment. The clinic used a “collaborative care model” which provided monitoring in addition to buprenorphine prescription, as well as nurse care managers who were responsible for the bulk of patient care.
Patients, on average, were 40 years old; 69% were male and the ethnic/racial composition was diverse with 49% White, 23% Black, 20% Latino, and 8% of another racial/ethnic background. The groups were similar on many measured characteristics when they started treatment in the hospital, including how often they used opioids, though the detox patients were more likely to have used cannabis and cocaine in the 30 days before treatment (28 vs. 45% and 53 vs. 69%, respectively), though these differences were not statistically significant.
By 1 month, linkage patients took buprenorphine, on average 22 days out of 30 (standard deviation = 10) versus 7 out of 30 in the detox group (standard deviation = 8).
Their opioid use, however, was similar during this time period, with 12 days of illicit opioid use in the linkage group (standard deviation = 8) versus 13 in the detox group (standard deviation = 8).
The initial STOP study based in hospital settings, and another study reviewed in a prior Bulletin which was based in emergency rooms both demonstrated innovative ways to engage individuals with opioid problems with helpful buprenorphine medication treatment.
In this latest analysis of the STOP study, in contrast with the positive linkage findings in the whole sample of individuals with opioid use disorder, injection users did not benefit from the active linkage to buprenorphine compared with detox and referral. As such, this study highlights the importance of examining subgroups of patients for whom the typical current standard of care may not be adequate
Suggestion in terms of what might be needed for this group of injection users, given that they were more likely to engage with buprenorphine treatment, but had similar outcomes:
More research is needed specifically on how to improve outcomes of hospitalized individuals with injection opioid use. It is possible that different combinations and intensities of medical, psychological, and community-based approaches might be needed.
Cushman, P. A., Liebschutz, J. M., Anderson, B. J., Moreau, M., & Stein, M. D. (2016). Buprenorphine Initiation and Linkage to Outpatient Buprenorphine Do Not Reduce Frequency of Injection Opiate Use Following Hospitalization. Journal of Substance Abuse Treatment.
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