Initiating buprenorphine treatment for opioid use disorder during short-term in-patient 'detoxification': a randomized clinical trial

Background and aims: The effectiveness of linking people from short-term in-patient managed withdrawal programs ('detoxification') to long-term, primary care-based buprenorphine is unknown. We tested whether buprenorphine initiation during an opioid withdrawal program and linkage to office-based buprenorphine (LINK) after discharge would increase engagement with office-based buprenorphine and decrease illicit opioid use during the ensuing 6 months compared with standard withdrawal management (WM).

Design: Single-site randomized controlled trial.

Setting: Short-term in-patient detoxification program in Massachusetts, USA.

Participants: People with opioid use disorder (n = 115) who averaged 32.4 years of age, 68.2% male, 79.1% white, using illicit opioids on 27.3 of the last 30 days, were randomly assigned to WM (n = 59) versus LINK (n = 56).

Intervention and comparator: Intervention was buprenorphine induction, in-patient dose stabilization and post-discharge transition to maintenance buprenorphine at an affiliated primary care clinic (LINK). Comparator was 5-day buprenorphine managed withdrawal protocol (WM).

Measurements: Mean 30-day rate of use of illicit opioids (primary aim) and prescribed buprenorphine (secondary aim) at 1, 3 and 6 months.

Findings: Compared with WM, participants in the LINK condition had lower illicit opioid use rates at days 12 [b = -6.81, 95% confidence interval (CI) = -9.69; -3.92, P < 0.001], 35 (b = -8.55, 95% CI - 11.63; -5.47, P < 0.001), 95 (b = -7.34, 95% CI = -10.59; -4.11, P < 0.001) and 185 (b = -3.52, 95% CI = -7.07; 0.27, P = 0.052). The LINK arm had higher prescription buprenorphine use rates (P < 0.001) at all assessments.

Conclusions: Among people with opioid use disorder, initiation of, and linkage to, office-based buprenorphine treatment post-discharge reduced illicit opioid use and increased days of buprenorphine treatment for up to 6 months post-discharge compared with an in-patient detoxification protocol.