A RANDOMIZED TRIAL OF BUPRENORPHINE MAINTENANCE FOR HEROIN DEPENDENCEIN A PRIMARY-CARE CLINIC FOR SUBSTANCE USERS VERSUS A METHADONE CLINIC

PURPOSE: Buprenorphine is an alternative to methadone for the maintena nce treatment of heroine dependence and may be effective on a thrice w eekly basis. Our objective was to evaluate the effect of thrice weekly buprenorphine maintenance for the treatment of heroin dependence in a primary care clinic on retention in treatment and illicit opioid use. SUBJECTS AND METHODS: Opioid-dependent patients were randomly assigne d to receive thrice weekly buprenorphine maintenance in a primary care clinic that was affiliated with a drug treatment program (n = 23) or in a traditional drug treatment program (n = 23) in a 12-week clinical trial. Primary outcomes were retention in treatment and urine toxicol ogy for opioids; secondary outcomes were opioid withdrawal symptoms an d toxicology for cocaine. RESULTS: Retention during the 12-week study was higher in the primary care setting (78%, 18 of 23) than in the dru g treatment setting (52%, 12 of 23; P = 0.06). Patients admitted to pr imary care had lower rates of opioid use based on overall urine toxico logy (63% versus 85%, P < 0.01) and were more likely to achieve 3 or m ore consecutive weeks of abstinence (43% versus 13%, P = 0.02). Cocain e use was similar in both settings. CONCLUSIONS: Buprenorphine mainten ance is an effective treatment for heroin dependence in a primary care setting. (C) 1998 by Excerpta Medica, Inc.