WASHINGTON — A team approach to managing opioid dependence with buprenorphine kept 32 of 37 patients (86%) on buprenorphine therapy at 4 months' follow-up, Daniel Alford, M.D., reported in a poster at the annual conference of the Association for Medical Education and Research in Substance Abuse.
The patients, aged 18–52 years, were mostly male (62%) and white (92%). The treatment protocol included an average of two in-person contacts and 15 phone contacts from a nurse care manager (NCM) in the first 2 weeks, followed by one to four contacts per week. Follow-up visits included random urine samples, pill counts, and observations of dosing.
The team approach featured extensive interaction between patients and nurse care managers, with physician assessments and consultations. The nurse made the initial assessment of each patient's substance use, medical and psychiatric history, and social support system by telephone.
Physicians reviewed and further assessed patients before enrolling them in the study and prescribing buprenorphine. The physicians also performed physical exams at enrollment and 4 months after treatment started.
The nurse care manager also obtained initial lab tests, educated the patients about buprenorphine, and reviewed patient responsibilities. The NCM devised an induction schedule based on physician guidelines, and was in frequent contact with the patients until they reached their stable maintenance doses. Patients had access to the nurse care managers by cell phone, he said at the conference, also sponsored by Brown Medical School.
After 4 months, only 13% of opioid urine tests were positive, compared with 100% at baseline, said Dr. Alford of Boston Medical Center. Ninety-two percent of the patients had social support for their treatment, and 56% were attending counseling sessions or mutual self-help meetings.
A majority of the patients (59%) had a medical comorbidity at baseline, but 68% had no usual source of primary care.