Safety and efficacy of long-term buprenorphine maintenance treatment (2011)

Background: There are limited data about postmarketing safety profile of buprenorphine for long-term maintenance treatment. In this observational study, we wanted to address the safety and efficacy of long-term buprenorphine maintenance treatment (BMT) for patients enrolled in Atlanta Veterans Administration Medical Center buprenorphine clinic from 2006 to 2010.
Methods: Records from all patients who are currently or had earlier been maintained on buprenorphine in the BMT program at the Atlanta Veterans Administration Medical Center during the years 2006 to 2010 were evaluated.
Results: The mortality rate in our cohort is 4% (3 of 77). None of them was drug related. The retention rate is 61% (47 of 77). There was significant improvement in opiate and cocaine illicit drug use from admission to most recent urine drug screen performed for the retained group (30% vs. 9%, P=0.0008 for opiate and 15% vs. 0%, P=0.007 for cocaine). The dropped out group did not show any statistically significant improvement for any illicit drug use. Length of time in treatment (chi²=21 and P<0.0001), recent opiate (chi²=5.7 and P=0.016), and recent cocaine use (chi²=5.7 and P=0.016) were the only individual variables that showed statistically significant correlation with dropping out of treatment. Recent cocaine use (chi²=9.5 and P=0.002) was the only individual variable that showed statistically significant correlation with recent opiate use.
Conclusions: Patient's retention in treatment is associated with significant reduction in illicit opiate and cocaine use. Therefore, this study supports long-term BMT, especially for opiate dependent patients who fail abstinent-based treatment. Patients receiving office-based buprenorphine treatment with comorbid cocaine and opiate dependence may have poor treatment outcome compared with patients without comorbid cocaine dependence. Therefore, it is important to address the cocaine comorbidity early in treatment. Our study confirms the safety and efficacy of BMT for long-term opiate maintenance treatment.