Integrating buprenorphine maintenance therapy into federally qualified health centers: real-world substance abuse treatment outcomes

Drug Alcohol Depend. 2013 Jul 1;131(1-2):127-35. doi: 10.1016/j.drugalcdep.2012.12.008. Epub 2013 Jan 17.

Abstract

Background: Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs).

Methods: Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months.

Results: Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days.

Conclusions: Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Buprenorphine / administration & dosage*
  • Cohort Studies
  • Connecticut / epidemiology
  • Female
  • Humans
  • Longitudinal Studies
  • Maintenance Chemotherapy / methods*
  • Maintenance Chemotherapy / trends
  • Male
  • Middle Aged
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / epidemiology*
  • Patient Protection and Affordable Care Act* / trends
  • Retrospective Studies
  • Substance Abuse Treatment Centers / methods*
  • Substance Abuse Treatment Centers / trends
  • Treatment Outcome
  • Young Adult

Substances

  • Buprenorphine