Factors Associated with Complicated Buprenorphine Inductions

New findings reveal the effects of prior drug use on a treatment for opioid addiction. Patient characteristics and elements of the treatment process had a significant effect on outcomes.

Providers of substance abuse treatment are often hesitant to provide buprenorphine for opioid (i.e., heroin or methadone) addiction. During buprenorphine induction, the first few days of treatment, some patients experience severe withdrawal symptoms: Precipitated withdrawal is the acute worsening of symptoms immediately after taking the first dose of buprenorphine. Protracted withdrawal consists of symptoms that persist beyond the first 24 hours of the initial buprenorphine dose. Patients who experience complications require additional time and resources from their providers.

This article presents a study that investigated possible causes of buprenorphine complications. The study took place from 2005 to 2008 at a community health center in the South Bronx. At the clinic, five general internists and one clinical pharmacist provided buprenorphine treatment. For this study, researchers examined medical records and a detailed drug use history for every patient who requested buprenorphine induction during the study period. Using bivariate analysis, researchers identified patient characteristics associated with buprenorphine complications.

Key Findings:

  • Patients with prior buprenorphine experience were less likely to experience complicated inductions.
  • Most of the patients who experienced complications, reported taking methadone prior to initiating buprenorphine induction.
  • The frequency of complications decreased as the study progressed, suggesting that providers became more proficient in inductions.

The findings presented in this article will improve buprenorphine induction treatment for opioid addiction in three ways: (1) by identifying appropriate candidates for induction; (2) by providing insight into the induction process itself; and (3) by encouraging more widespread adoption of buprenorphine treatment.