Comparison of high-dose buprenorphine treatments of opiate-dependent outpatients in four healthcare networks

Aims. - The aim of this study was to compare the various clinical practices in four health care networks and to access how the variations in treatment effected the outcome in opiate-dependent patients. Methods. - A retrospective study was carried out with 71 participating gene ral practitioners. These were chosen from a group of 354 practitioners from four health rare networks. Each practitioner could enroll up to 5 patients who were currently undergoing treatment,vith high-dose buprenorphine(1)(HD B). The patients treatment had to have been initiated between the 1(st) of February 1996 and the 31(st) of October 1996, and excluded any patients who had lapsed on their treatment during the first month. Patients were select ed until a total of 75 cases were enrolled from each network. Data sere the n collected retrospective ly between June and December 1997, Information co llected concerned the initial stage of treatment, the stabilizing stage or level of treatment and Followed up data on the most recent prescriptions. Results. - The final patient maintenance totals were high for all four rare networks (82.7 to 96% of patients were still being followed by their dorte r at the final evaluation). A positive outcome as indicated by reduction of risk and decreased social vulnerability was also observed in all networks. Additionally, in each network there was a dear correlation between prescri ption practices and patient behavior. For example, the prescription of HDB at a daily dose of less than 6.2mg was associated with a higher rate of ben zodiazepine use; and prescription of several daily doses of HDB was associa ted with a higher percentage of injecting patients. Conclusion. - This retrospective study provides evidence that general pract itioner care of drug-dependent patients as outpatients, within a health tar t: network helps to stabilize patient visits, allows treatment of associate d comorbidities and favors social rehabilitation, The prescription of HDB a s a single daily dose, individually adapted for each patient, optimizes the outcome and reduces misuse.