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 presented at the annual conference of the Association for Medical Education and Research in Substance Abuse.
The patients, who were aged 18–52 years, began treatment over a 6-month period. Most were 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 during 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 care manager made the initial assessment of each patient's substance use, medical and psychiatric history, and social support system by telephone, Dr. Alford said.
Physicians reviewed and further assessed the patients before enrolling them in the study and prescribing buprenorphine.
The physicians also performed physical exams at enrollment and 4 months after the start of treatment.
The nurse care manager also obtained initial lab tests, educated the patients about buprenorphine, and reviewed patient responsibilities.
The nurse case manager 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, Dr. Alford said at the conference, which was 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, who is with 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, he reported.
A majority of the patients (59%) had a medical comorbidity at baseline, but 68% had no usual source of primary care. Further, 54% reported psychiatric comorbidity, but only 20% had received psychiatric care prior to the study.